Siu Wing Yu Sharon, Hong Mun-Kun, Ding Dah-Ching
Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Hualien 970, Taiwan.
Minimally Invasive Gynecology Surgery Center, Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Hualien 970, Taiwan.
World J Clin Cases. 2023 Jul 26;11(21):5160-5166. doi: 10.12998/wjcc.v11.i21.5160.
Large-cell neuroendocrine carcinoma (NEC) is an uncommon type of tumor that can occur in the endometrium. This aggressive cancer requires definitive management. Here, we describe the clinical characteristics and treatment of a postmenopausal woman with large cell NEC of the endometrium.
A 55-year-old Asian female presented with a 1-year history of postmenopausal vaginal bleeding. Transvaginal ultrasound revealed a thickened endometrium (30.2 mm) and a hypervascular tumor. Computed tomography revealed that the tumor had invaded more than half of the myometrium and spread to the pelvic lymph nodes. The tumor marker, carcinoembryonic antigen, was elevated (3.65 ng/mL). Endocervical biopsy revealed high-grade endometrial carcinoma. She underwent radical hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and bilateral pelvic and para-aortic lymph node dissection. Pathological examination revealed mixed neuroendocrine and endometrioid adenocarcinoma, pT2N0M0, grade 3, and International Federation of Gynecology and Obstetrics stage 2. Immunohistochemistry showed moderate estrogen and progesterone receptor expressions (20% and 1%, respectively), focal CD56 expression (NEC marker), positive staining for vimentin, p53 (wild type), and ki67 (90%), and loss of expression of PMS2 (Lynch syndrome marker). The patient received five cycles of cisplatin and etoposide after surgery. No recurrence was noted after 5 mo.
We report the characteristics and successful management of a rare case of large-cell endometrial NEC concomitant with Lynch syndrome.
大细胞神经内分泌癌（NEC）是一种可发生于子宫内膜的罕见肿瘤类型。这种侵袭性癌症需要明确的治疗。在此，我们描述一位患有子宫内膜大细胞NEC的绝经后女性的临床特征及治疗情况。
一名55岁亚洲女性，有1年绝经后阴道出血病史。经阴道超声显示子宫内膜增厚（30.2mm）及高血管性肿瘤。计算机断层扫描显示肿瘤侵犯超过一半的肌层并扩散至盆腔淋巴结。肿瘤标志物癌胚抗原升高（3.65ng/mL）。宫颈活检显示高级别子宫内膜癌。她接受了根治性子宫切除术、双侧输卵管卵巢切除术、大网膜切除术以及双侧盆腔和腹主动脉旁淋巴结清扫术。病理检查显示为神经内分泌和子宫内膜样腺癌混合，pT2N0M0，3级，国际妇产科联盟分期为2期。免疫组化显示雌激素和孕激素受体呈中度表达（分别为20%和1%），局灶性CD56表达（NEC标志物），波形蛋白、p53（野生型）和ki67（90%）染色阳性，以及PMS2表达缺失（林奇综合征标志物）。患者术后接受了5个周期的顺铂和依托泊苷治疗。5个月后未发现复发。
我们报告了一例罕见的伴有林奇综合征的子宫内膜大细胞NEC的特征及成功治疗情况。
