Primary large cell neuroendocrine carcinoma of the urinary bladder

Abstract

Large cell neuroendocrine carcinoma (LCNEC) of the urinary bladder is rare. It is a type of neuroendocrine carcinoma morphologically distinct from small cell carcinoma. We report here a case of primary LCNEC of the urinary bladder. We observed a very large invasive tumor, which was not able to be detected three months previously by cystoscopy or computed tomography. The tumor cells morphologically and immunohistochemically resembled that of pulmonary LCNEC. With prompt cystoprostatectomy and chemotherapy, the patient is free of disease 16 months after diagnosis. Although LCNEC is usually very aggressive, it may be controlled by early diagnosis and treatment.

Primary “Pure” Large Cell Neuroendocrine Carcinoma of the Urinary Bladder: A Case Report and Review of the Literature

“…3 Histologic features of LCNEC include large polymorphic tumor cells which are 3 times larger in diameter than a small resting lymphocyte, low nucleus/cytoplasm ratio, coarse chromatin with frequent prominent nucleoli, very high mitotic rate (10 or more mitoses per 10 HPF), abundant necrosis, specific growth patterns (rosette, trabeculae, and palisade formation), and positive immunohistochemical staining for one or more neuroendocrine markers along with characteristic ultrastructural findings. [1][2][3][4][5]7,8 Similar to the current case, at the time of presentation, the major complaint in 80% of patients is gross hematuria, while 30% also experience dysuria syndrome. 3,5 This type of tumor has been shown to grow quickly, and in the great majority of cases, the distant metastases are already present at the time of diagnosis.…”

“…1,3,5 This fact favors the hypothesis that neuroendocrine cells originate from multipotent stem cells of bladder mucosa, which suggests the common origin of neuroendocrine, urothelial, squamous, or adenocarcinoma tumor component. 1,6,8 LCNEC has significant male gender predilection, as almost 80% of diagnosed subjects were men, while the mean age at the time of diagnosis is close to 60 years. 3 Histologic features of LCNEC include large polymorphic tumor cells which are 3 times larger in diameter than a small resting lymphocyte, low nucleus/cytoplasm ratio, coarse chromatin with frequent prominent nucleoli, very high mitotic rate (10 or more mitoses per 10 HPF), abundant necrosis, specific growth patterns (rosette, trabeculae, and palisade formation), and positive immunohistochemical staining for one or more neuroendocrine markers along with characteristic ultrastructural findings.…”

“…1,[3][4][5][6] To date, only 21 cases of bladder LCNEC of pure and mixed histology have been reported in the world literature, 7 but it seems possible that this type of neoplasm was previously underdiagnosed. 3,8 Diagnostic criteria for bladder LCNEC are based on those made for pulmonary LCNEC first described by Travis et al 1,2,4,7,9 This report describes a case of pure primary LCNEC of the urinary bladder.…”

Large Cell Neuroendocrine Carcinoma of the Urinary Bladder: Case Report and Review

“…Primary SCCB is a rare disease that accounts for less than 0.7% of all bladder cancers [29,30]. Primary LCCB is an even rarer disease first described in 1986 [4] and with 17 more cases reported since then [5,6,7,8,9,10,11,12,13,14,15,16]. …”

“…Large cell carcinoma of the urinary bladder (LCCB) was first reported in 1986 [4] and since then 17 more cases have been described on the literature [5,6,7,8,9,10,11,12,13,14,15,16]. Because of the relative rarity of these tumors there is no standard approach for managing SCCB [17] or LCCB [13].…”