Combined Large Cell Neuroendocrine and Endometrioid Carcinoma of the Endometrium

Abstract

We present the surgical and pathological findings and follow-up of 5 women diagnosed with combined endometrioid and high-grade neuroendocrine carcinoma of large cell type (LCNEC) arising in the endometrium. The mean age of the women was 75 years (range, 50-88 years). Of the 5 tumors, 4 formed polypoid endometrial masses associated with extensive lymphovascular involvement of the myometrium by neoplastic cells. A single endometrial tumor was formed by LCNEC alone, and 4 tumors were composite with varying proportions formed by endometrioid (4/5) and small cell neuroendocrine carcinoma (1/5). In all 5 LCNEC tumor components, an insular growth pattern was noted, whereas a diffuse (solid) pattern was found in 4 tumors, a trabecular in 2, and rosettes/pseudorosettes in another 2. In all 5 tumors, the LCNEC tumor components were labeled with neuron-specific enolase (NSE). Four tumors were reactive for chromogranin A, CAM 5.2, and p53. Three tumors were labeled for AE1/AE3, CD56 (NCAM), p16, and cytokeratin 7. Synaptophysin was reactive in 2 tumors, and CD117 was found in only a single tumor. Of the 3 endometrioid tumor components examined, all were reactive for NSE. Two tumors were reactive for p16 and p53, 1 for CD56, but none for synaptophysin orchromogranin A. We conclude that LCNEC of the endometrium is a distinct clinicopathological entity with a poor prognosis irrespective of stage. The gross and histomorphological features are often suggestive, but confirmation requires immunoperoxidases, including NSE, synaptophysin, chromogranin A, p16, and p53. Combined endometrioid and high-grade LCNEC possess more characteristics of a type II than a type I endometrial carcinoma.

Expression of neuroendocrine markers in endometrial carcinomas — an immunohistochemical analysis

“…However, in two mixed cancers, neuroendocrine solid pattern with atypical structure for this type of cancer deeply infiltrated uterus muscle wall; endometrioid pattern constitutions were limited to the endometrium. Similar morphological pictures have been frequently described in the literature [4,5,13,14,18,20,21]. Histogenesis of such cancer pattern is not clear.…”

“…The less differentiated the cancer and the deeper the infiltration of the uterus wall, the poorer the prognosis. Poorly differentiated and undifferentiated endometrial cancers comprise 2% of all endometrial cancers and frequently create mixed cell populations with different prognoses [3,5,[13][14][15][16]19].…”

“…Recently, articles have been published about the coexistence of undifferentiated cancers, serous and endometrioid, with focal positive immunoreactions for one or more neuroendocrine markers without morphological transformation into neuroendocrine cancer [5,[13][14][15][16][17]. This phenomenon is not well known and needs additional studies.…”

Benign Endometrial Polyp and Primary Endometrial Small Cell Neuroendocrine Carcinoma Confined to the Polyp: A Rare Association

“…Adenoskuamöz yada endomerioid tip endometrial karsinomlar en sık ikincil komponent olarak bildirilmiş olup, olguların %50-%80'i FİGO grade 1 yada FİGO grade 2 endometrioid tip endometrial karsinomlardır [2,[4][5][6]. Karsinosarkom ve papiller seröz karsinom birliktelikleride bildirilmiştir [7,8].…”

Small cell carcinoma in endometrium on the base of extensive adenomyosis: differential diagnosis with immunochemistry

“…In the endometrium, the SCC component is frequently combined with more differentiated tumors like endometrioid adenocarcinomas and serous carcinomas, and may also represent a component of malignant mixed Mullerian tumor (MMMT) [3]. A review of the literature revealed approximately 49 PD endometrial NETs (41 SCC, and 8 LCNEC), 22 of which were combined with endometrioid adenocarcinoma [4][5][6][7][8][9][10][11][12], 2 with adenosquamous carcinoma [6], 2 with serous carcinoma [13,14], and 3 were a component of an MMMT [3]. But to the best of our knowledge, the concomitant existence of SCC, endometrioid adenocarcinoma, and serous carcinoma arising in the endometrium has not been previously reported in the English literature.…”