Endocrine Abstracts

Background: Lu-NETs are a heterogeneous family of neoplasms ranging from quite indolent lesions with extremely aggressive tumors with very poor prognosis. These neuroendocrine entities are further summarized into two groups according to their biological aggressiveness: Well-differentiated: carcinoids typical (G1) and atypical (G2).Poorly-differentiate: SCLC (Combined) and LCNEC (Combined) (G3). Alarm signal on the aggressive evolution of the SCLC

Case report: Female, 60- ys. old, consult the doctor for Atrial Fibrillation. Chest x-rays: lobar atelectasis top left. CT scan: 1. lobar atelectasis top left by total obstruction from the origin of left upper lobar. 2. Lymph node metastases in hill and mediastinum. Bronchial biopsy: tumor infiltrated with insular architecture, small cells, high nuclear/cytoplasm ratio partly free chromatin, big round nuclei, bizarre cell bodies = Small Cell Lung Neuroendocrine Carcinoma (SCLC). IHC: TTF1-intensely positive in tumor cells. Cromogranin intensely positive. Synaptofizin-positive. CK7-negative. Ki67–25%positive. Treatment: Chemotherapy + radiotherapy. After nine months CT abdomen: tumoral mass in left adrenal, possible MTS. After another two months: Carcinoid syndrome: flushing, diarrhea, bronchoconstriction, tachycardia episodes. Biochemical markers: neuron specific enolase- increased chromogranin A- slightly increased. Treatment: Sandostatin LAR 20 mg/28 days. After 14 months of the diagnostic, the patient dies with cerebral MTS.

Conclusions: SCLC, is a highly aggressive disease; a young woman, with no smoking history, with a short period of stabilization after the treatment, develops quickly brain MTS and dies in short time.