Upper New York State Society of Cytology, Inc.

Interesting Case 1

Submitted by: Sharon Leo, MS, CT(ASCP). CMIAC

University of Rochester Medical Center, Rochester, NY

History

A 38-year-old woman with a history of scoliosis consulted her physician for back pain, chronic cough, bronchitits, and dyspnea. She had a smoking history. A chest X-ray revealed a 2.5 cm nodule in the left lower lobe. A fluoroscopically guided fine-needle aspiration(FNA) was performed.

Cytologic Findings

The sample was markedly cellular with a granular and hemorrhagic background. The cellular pattern consisted of sheets, syncytial groups, loose aggregates, single cells, and stripped nuclei. The "pulled out" DNA streaming was salient. The predominately medium sized cells varied in size and shape. The majority of nuceli were round or oval and markedly hyperchromatic.The nuclear chromatin was predominately coarse, but ranged from finely granular to opaque. Nuclear borders ranged from regular to irregular. Small to prominent nucleoli were observed with some frequency. Cytoplasm ranged from a wisp to a moderate amount. The cytoplasmic staining varied.

A left lower lobectomy was done.

Diagnosis/Discussion

Malignant tumor cells present derived from large-cell neuroendocrine carcinoma.

Large-cell neuroendocrine carcinoma(LCNEC) is an aggressive tumor with a survival rate similar to small cell carcinoma(SCC). Because it is new classification and a relatively rare tumor, it is still treated clinically as a SCC(excision and SCC-type chemotherapy)(1). There have not been enough cases studied to determine the optimal treatment.

LCNEC has an age range of 35 to 75 years with a median age of 64(1). It may be difficult to differentiate from a SCC, but LCNEC does differ from SCC in a few ways. LCNEC nuceli are medium sized and slightly larger than SCC nuclei. LCNEC has obvious small to prominent nucleoli in occasional nuclei. SCC has absent or inconspicuous nucleoli. There is more nuclear molding in a SCC than the occasional molding seen in LCNEC. The single cells and aggregates of LCNEC may have a small to moderate amounts of cytoplasm compared to a wisp or absent cytoplasm of the SCC.

The tissue has an neuroendocrine appearance of organoid nests, trabecular formations, rosettes, and acini. Neuroendocrine markers may be helpful. It has been our experience that tissue from a LCNEC may sometimes look similar to an adenocarcinoma.

The patient had a Stage 1 tumor and received no further treatment. She remains disease eight years after surgery.

References:

Leo S. Fine-needle aspiration cytodiagnosis of pulmonary neuroendocrine carcinoma. ASCP Tech Sample. 2002: 23-28.