Du Ran, Jiang Feng, Wang Zheng-Yan, Kang Yan-Qing, Wang Xiu-Yu, Du Ying
Department of Pathology, Liaocheng People's Hospital, Liaocheng 252000, Shandong Province, China.
Department of Thoracic Surgery, Liaocheng Tumor Hospital, Liaocheng 252000, Shandong Province, China.
World J Clin Cases. 2021 May 16;9(14):3449-3457. doi: 10.12998/wjcc.v9.i14.3449.
Large cell neuroendocrine carcinoma (LCNEC) of the endometrium is an uncommon and highly aggressive tumor that has not been comprehensively characterized. We report a case of pure endometrial LCNEC and review the current literature of similar cases to raise awareness of the histological features, treatment, and prognosis of this tumor.
We report the case of a 73-year-old woman who presented with irregular postmenopausal vaginal bleeding. Ultrasonography showed an enlarged uterus and a 5.1 cm × 3.3 cm area of medium and low echogenicity in the uterine cavity. Biopsy by dilatation and curettage suggested poorly differentiated carcinoma. Magnetic resonance imaging revealed a heterogeneously enhanced uterine tumor with diffuse infiltration of the posterior wall of the uterine myometrium and enlarged pelvic lymph nodes. The patient underwent a hysterectomy and bilateral adnexal resection. Gross observation revealed an ill-defined white solid mass of the posterior wall of the uterus infiltrating into the serosa with multiple solid nodules on the serous surface. Microscopically, the tumor cells showed neuroendocrine morphology (organoid nesting). Immunohistochemistry revealed the tumor cells were diffusely positive for the neuroendocrine markers CD56, chromogranin A, and synaptophysin. Thus, the tumor was diagnosed as stage IIIC endometrial LCNEC.
Pathologic findings and immunohistochemistry are essential in making a diagnosis of endometrial LCNEC.
子宫内膜大细胞神经内分泌癌（LCNEC）是一种罕见且侵袭性很强的肿瘤，目前尚未得到全面的特征描述。我们报告一例纯子宫内膜LCNEC病例，并回顾类似病例的现有文献，以提高对该肿瘤组织学特征、治疗及预后的认识。
我们报告一名73岁女性，因绝经后阴道不规则出血就诊。超声检查显示子宫增大，宫腔内有一个5.1 cm×3.3 cm的中等及低回声区。刮宫活检提示低分化癌。磁共振成像显示子宫肿瘤不均匀强化，子宫肌层后壁弥漫性浸润，盆腔淋巴结肿大。患者接受了子宫切除术及双侧附件切除术。大体观察显示子宫后壁有一个边界不清的白色实性肿块，浸润至浆膜层，浆膜表面有多个实性结节。显微镜下，肿瘤细胞呈神经内分泌形态（器官样巢状结构）。免疫组化显示肿瘤细胞神经内分泌标志物CD56、嗜铬粒蛋白A和突触素弥漫阳性。因此，该肿瘤被诊断为IIIC期子宫内膜LCNEC。
病理检查结果及免疫组化对于子宫内膜LCNEC的诊断至关重要。
