Clinical characterization of pulmonary large cell neuroendocrine carcinoma and large cell carcinoma with neuroendocrine morphology

Abstract

BACKGROUND Large cell carcinoma has been classified as four potential types based on its neuroendocrine morphology and evidence of neuroendocrine differentiation discernible by immunohistochemistry or electron microscopy. However, the clinical relation among these four categories has not been clearly defined. In 1999, the World Health Organization (WHO) categorized large cell neuroendocrine carcinoma as a variant of large cell carcinoma. MATERIAL AND METHODS The authors analyzed 119 cases of large cell carcinoma from a total of 2070 primary lung carcinoma cases resected surgically between 1969–1999. Using light microscopy, electron microscopy, and immunohistochemical staining, the authors reclassified these cases into large cell neuroendocrine carcinoma (LCNEC), large cell carcinoma with neuroendocrine differentiation (LCCND), large cell carcinoma with neuroendocrine morphology (LCCNM), and classic large cell carcinoma (CLCC). RESULTS In multivariate analyses, the authors found that large cell carcinoma with neuroendocrine features, which combined LCNEC, LCCND, and LCCNM, impacted both the overall survival and disease‐free survival of patients. The clinical behavior of LCCNM was similar to that of LCNEC. CONCLUSIONS Large cell carcinomas with neuroendocrine features appear to be more clinically aggressive than CLCCs. The authors' findings suggest that the histologic identification of neuroendocrine features in tumor tissue from patients diagnosed with large cell carcinoma of the lung may have clinical relevance. Cancer 2001;91:1992–2000. © 2001 American Cancer Society.

Pulmonary and extrapulmonary poorly differentiated large cell neuroendocrine carcinomas

“…3 The LCNEC subgroup is a recently recognized pathologic entity 6,7 and accounts for < 5% of lung, digestive, or undetermined origin carcinomas. [8][9][10][11][12][13][14] LCNECs initially were characterized by an intermediate survival between well-differentiated NEC and SCC. 3 The question of whether LCNEC should be considered as part of the NET spectrum remains unanswered.…”

“…31,32 We observed a 24% 5-year overall survival rate and a 31-month median survival in patients with poorly differentiated LCNEC patients, in line with previous studies that demonstrated a 5-year survival rate between 13% and 57%. 3,8,9,11,22,27,28 In the current study, a high mitotic count and a low number of neuroendocrine markers at immunohistochemistry emerged as prognostic factors for survival in patients with poorly differentiated LCNEC. For the first time, we have identified relevant prognostic impact for the mitotic count in poorly differentiated LCNEC: Patients with < 37 mitoses per 10 HPFs had tumors that were characterized by a less aggressive behavior.…”

Pathological diagnosis of pulmonary large cell neuroendocrine carcinoma by endobronchial ultrasound‐guided transbronchial needle aspiration

“…Large cell neuroendocrine carcinoma (LCNEC) is a rare subtype of neuroendocrine carcinoma that accounts for approximately 3% of lung cancers 1. The prognosis of patients with LCNEC is reported to be poor, with five‐year survival rates of 15–57% 2.…”

Clinicopathological features and the impact of the new TNM classification of malignant tumors in patients with pulmonary large cell neuroendocrine carcinoma

“…Patients with LCNEC have an extremely poor prognosis since the biological behavior of LCNECs is similar to that of small cell lung carcinomas and LCNECs also have characteristics of high-grade neuroendocrine tumors (1)(2)(3)(4)(5)(6)(7)(8)(9). However, the treatment for patients with LCNEC has been based on non-small cell carcinomas.…”