Lung tumor - Large cell neuroendocrine carcinoma

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Lung tumor

Other Carcinoma

Large cell neuroendocrine carcinoma

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 12 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Aggressive carcinoma composed of large malignant cells which display neuroendocrine characteristics; characterized by high mitotic activity and necrotic change (WHO)
● Rosai: resembles non-small cell carcinoma, but on closer inspection has a hint of neuroendocrine architecture confirmed by special stains
● More likely to develop recurrent lung cancer and have shorter actuarial survival than patients with other histologic types of NSCLC, even in those with stage I disease (Cancer Control 2006;13:270)

Micro description
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● Larger tumor cells than atypical carcinoid, high nuclear grade, increased mitotic activity (11+ per 10 HPF) and necrosis (Arch Pathol Lab Med 2010;134:1628)
● Poorly developed neuroendocrine architecture with some pallisading or rosette-like structures present
● Oncocytic neuroendocrine tumor: low grade or high grade; oncocytic features, but similar clinically to nononcocytic tumors (Hum Pathol 2011;42:578)

Micro images
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Large cell neuroendocrine versus small cell neuroendocrine carcinoma

CD117, HER2, EGFR

Phosphohistone H3

Metastases from lung primaries

Positive stains
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● Neuroendocrine markers, CD117 (60%), TTF1 (50%)
● Phosphohistone H3 recommended for counting mitotic figures (Am J Clin Pathol 2011;136:252)
● GLUT1 (74%, Mod Pathol 2009;22:633)
● Enhancer of zeste homolog 2 (EZH2): diffusely and strongly positive in all small-cell carcinomas and large-cell neuroendocrine carcinomas (Hum Pathol 2011;42:867)

End of Lung tumor > Other carcinoma > Large cell neuroendocrine carcinoma

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