A case of uterine corpus large cell neuroendocrine carcinoma showing prominent myometrial invasion without any macroscopically clear tumor formation
Tóm tắt
Large cell neuroendocrine carcinoma (LCNEC) arising in the uterine corpus is a very rare. Here, we report our experience with a primary LCNEC in the uterine corpus that showed prominent myometrial invasion without exhibiting any macroscopically distinct tumor formation in the uterine cavity. The patient was a 54-year-old woman. She had a past medical history of right breast cancer and was referred to our department with irregular genital bleeding, elevated serum carcinoembryonic antigen in periodic medical examinations and computed tomography (CT) findings of uterine cavity dilation. Endometrial biopsy suggested a poorly differentiated tumor. Although magnetic resonance imaging (MRI) showed hematometra-like findings in the uterine cavity, it did not indicate any clear endometrial lesion. The myometrium was unequally thickened, and the entire muscle layer showed a high signal intensity on diffusion-weighted images. Fluorine-18-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed strong FDG accumulation in the whole uterus, and on the bottom of the uterus, there was a ring-shaped accumulation mainly in the muscle layer. The postoperative resected specimen did not show any tumor formation in the uterine cavity, whereas the myometrium was hard and thickened, and colored white overall. Histopathological examination revealed prominent myometrial invasion in most layers, cervical stromal invasion and pelvic lymph node metastasis. The diagnosis was a LCNEC of the uterine corpus, at FIGO stage IIIC1 and pT2N1M0. With these patients, we found that functional metabolic images, such as MRI diffusion-weighted images and FDG-PET/CT, were useful in identifying the lesion. Preoperatively, when a poorly differentiated tumor is estimated and characteristic myometrial invasion is suspected, the possibility of LCNEC should be considered.
Tài liệu tham khảo
Asamura H, Kameya T, Matsuno Y et al (2006) Neuroendocrine neoplasms of the lung: a prognostic spectrum. J Clin Oncol 24:70–76
Erhan Y, Dikmen Y, Yucebilgin MS et al (2004) Large cell neuroendocrine carcinoma of the uterine corpus metastatic to brain and lung: case report and review of the literature. Eur J Gynaecol Oncol 25:109–112
Mulvany NJ, Allen DG (2008) Combined large cell neuroendocrine and endometrioid carcinoma of the endometrium. Int J Gynecol Pathol 27:49–57
Albores-Saavedra J, Martinez-Benitez B, Luevano E (2008) Small cell carcinomas and large cell neuroendocrine carcinomas of the endometrium and cervix: polypoid tumors and those arising in polyps may have a favorable prognosis. Int J Gynecol Pathol 27:333–339
Terada T (2010) Large cell neuroendocrine carcinoma with sarcomatous changes of the endometrium: a case report with immunohistochemical studies and molecular genetic study of KIT and PDGFRA. Pathol Res Pract 206:420–425
Deodhar KK, Kerkar RA, Suryawanshi P et al (2011) Large cell neuroendocrine carcinoma of the endometrium: an extremely uncommon diagnosis, but worth the efforts. J Cancer Res Ther 7:211–213
Shahabi S, Pellicciotta I, Hou J et al (2011) Clinical utility of chromogranin A and octreotide in large cell neuro endocrine carcinoma of the uterine corpus. Rare Tumors 3:e41
Makihara N, Maeda T, Nishimura M et al (2012) Large cell neuroendocrine carcinoma originating from the uterine endometrium: a report on magnetic resonance features of 2 cases with very rare and aggressive tumor. Rare Tumors 4:e37
Nguyen ML, Han L, Minors AM et al (2013) Rare large cell neuroendocrine tumor of the endometrium: a case report and review of the literature. Int J Surg Case Rep 4:651–655
Tanimoto H, Hamasaki A, Akimoto Y et al (2012) A case of large cell neuroendocrine carcinoma (LCNEC) of the uterine cervix successfully treated by postoperative CPT-11 + CDDP chemotherapy after non-curative surgery. Gan To Kagaku Ryoho 39:1439–1441 (in Japanese)
Miyasaka N, Kubota T (2011) Unusually intense 18F-fluorodeoxyglucose (FDG) uptake by a mature ovarian teratoma: a pitfall of FDG positron emission tomography. J Obstet Gynaecol Res 37:623–628
Nishijima N, Kajihara M (2014) A case of mature cystic teratoma presenting intense FDG uptake. Jpn J Clin Radiol 59:1769–1773