combined neuroendocrine tumor in lung

[sleeping beauty]

---

Members do not see this ad.

did anyone see lung tumor with a mix of multiple neuroendocrine types of tumor cells? i guess many of you may see combined small cell and large neruoendocine ca.

what about carcinoid tumor + small cell carcinoma?

i have to present a consultation case from another hospital that was signed out as carcinoid tumor by attendings from that hosp and our program. for me it seems that 45% of tumor mass are typical carcinoid and 45% are small cells. they are seperated by 10% ""transional zone cells"" that look like carcinoid but with nuclear pleomorphism (no mitotic fig.)

 

[b&ierstiefel]

did anyone see lung tumor with a mix of multiple neuroendocrine types of tumor cells? i guess many of you may see combined small cell and large neruoendocine ca.

what about carcinoid tumor + small cell carcinoma?

i have to present a consultation case from another hospital that was signed out as carcinoid tumor by attendings from that hosp and our program. for me it seems that 45% of tumor mass are typical carcinoid and 45% are small cells. they are seperated by 10% ""transional zone cells"" that look like carcinoid but with nuclear pleomorphism (no mitotic fig.)

I've seen carcinoid + small cell before but they were two separate primaries in different lobes of the lung. The small cell carcinoma was an unexpected finding.

Any necrosis in the carcinoid component? If so, that would bump that up to an atypical carcinoid.

 

[sleeping beauty]

no necrosis.

zone 1 is the extremely typical carcinoid: nests of very uniform round nuclei with eosinophilic cytoplasm surounded by delicate fibrovascular strom. cells in the transitional area have larger nuclei with different sizes or binuclei. some nests in zone 2 also contain some very typical cells like those in zone 1. i consider zone 2 atypical but there is no mitosis. it does not fit the dx of atypical. cells in zone 3 are stained darker and have angular nuclei, little cytoplasm, nuclear molding. the mass is just below respiratory epithelia and wraps around cartilate. 2.5 cm in greatest dimension.

 

[b&ierstiefel]

no necrosis.

zone 1 is the extremely typical carcinoid: nests of very uniform round nuclei with eosinophilic cytoplasm surounded by delicate fibrovascular strom. cells in the transitional area have larger nuclei with different sizes or binuclei. some nests in zone 2 also contain some very typical cells like those in zone 1. i consider zone 2 atypical but there is no mitosis. it does not fit the dx of atypical. cells in zone 3 are stained darker and have angular nuclei, little cytoplasm, nuclear molding. the mass is just below respiratory epithelia and wraps around cartilate. 2.5 cm in greatest dimension.

Sounds like you have a cool case then...probably some clonal aberration giving rise to the small cell.

 

[Neddy]

no necrosis.

zone 1 is the extremely typical carcinoid: nests of very uniform round nuclei with eosinophilic cytoplasm surounded by delicate fibrovascular strom. cells in the transitional area have larger nuclei with different sizes or binuclei. some nests in zone 2 also contain some very typical cells like those in zone 1. i consider zone 2 atypical but there is no mitosis. it does not fit the dx of atypical. cells in zone 3 are stained darker and have angular nuclei, little cytoplasm, nuclear molding. the mass is just below respiratory epithelia and wraps around cartilate. 2.5 cm in greatest dimension.

What's the mitotic activity in "zone 3"? Neat case BTW.

 

[raider]

To make it simple 😀, the only feature you should really be concentrating on is mitotic rate and necrosis. Anything more than 2 mf/10 hpf or necrosis, time to reconsider the carcinoid diagnosis. As in all neuroendocrine tumor, pleomorphism is not that important.
Go to "Neuroendocrine tumors of the lung with proposed criteria for large-cell neuroendocrine carcinoma. An ultrastructural, immunohistochemical, and flow cytometric study of 35 cases. Am J Surg Pathol. 1991 Jun;15(6):529-53 ". You will have all your answers.
Best of luck!🙂
(Would be nice if you can share some pictures)

PS. My own hypothesis is the spectrum is (carcinoid-atypical carcinoid-large cell neuroendocrine carcinoma) with small cell being an entirely different entity. I have seen carcinoid in juxtaposition to atypical carcinoid and large cell neuroendocrine carcinoma. But if I seen a carcinoid in juxtaposition to a small cell carcinoma, I would rather be thinking collision tumor rather than tumor progression.

 

[LADoc00]

huh? small cell is a totally different entity than carcinoid.

If there is mits and necrosis, then it is an atypical carcinoid. If it just looks funny, then it isnt crap.

 

[raider]

Cancer Res. 1999 Oct 15;59(20):5119-22.Classification of small cell lung cancer and pulmonary carcinoid by gene expression profiles.
Appl Immunohistochem Mol Morphol. 2000 Mar;8(1):49-56.Gene product immunophenotyping of neuroendocrine lung tumors. No linking evidence between carcinoids and small-cell lung carcinomas suggested by multivariate statistical analysis.

 

[paleman]

though the classification of pulmonary neuroendocrine tumors remains imperfect, most agree small cell is not completely different from carcinoid. they probably represent entities at opposite ends of a spectrum.. with regards to neuroendocrine carcinomas, small and large morphologies share genetic alterations suggesting a monoclonal origin from a common ancestor. large cell neuroendocrine carcinoma and small cell carcinoma also share a similar prognosis. there are no comprehensive studies to determine whether a tumor showing features of both typical carcinoid and small or large cell has a favorable prognosis compared to pure large or small cell (these tumors are f^&$^@g rare).

 

[sleeping beauty]

though the classification of pulmonary neuroendocrine tumors remains imperfect, most agree small cell is not completely different from carcinoid. they probably represent entities at opposite ends of a spectrum.. with regards to neuroendocrine carcinomas, small and large morphologies share genetic alterations suggesting a monoclonal origin from a common ancestor. large cell neuroendocrine carcinoma and small cell carcinoma also share a similar prognosis. there are no comprehensive studies to determine whether a tumor showing features of both typical carcinoid and small or large cell has a favorable prognosis compared to pure large or small cell (these tumors are f^&$^@g rare).

i agree with this post.