Within the spectrum of purer neuroendocrine tumors, the extremely rare prostatic carcinoid is now officially labeled as well-differentiated neuroendocrine tumor (carcinoid), the aggressive small cell neuroendocrine carcinoma (SCNEC) is retained, and the new group of LCNEC
Sixty patients have been excluded as they had SCLC and one patient has been excluded as she had a LCNEC
. We excluded the patients with LCNEC
or SCLC due to the biological and clinical differences between these tumors and the other bronchial NET.
Another debatable aspect in LCNEC
management is radiotherapy and prophylactic cranial irradiation (PCI) in early stages.
She was diagnosed with stage IV LCNEC
with distant metastasis.
This carcinoma was histologically distinct from the previous prostate adenocarcinoma and consistent with large cell neuroendocrine carcinoma (LCNEC
To the best of our knowledge this is a first case of LCNEC
with rectal involvement; more importantly it presented with resistant hypokalaemia in our patient which posed a challenge before trephine colostomy.
The large-scale genomic studies of NSCLC by The Cancer Genome Atlas (TCGA) consortium and others have supported that Nrf2 deregulation represents one of the major cancer driver pathways in the specific histotypes of SqCC where cigarette exposure can activate the oxidant stress response  and LCNEC
of the lung with Non-Small-Cell Carcinoma features [77, 78].
This article represents the first review in the English literature that has compiled data about patients' demographics, presenting symptoms and treatment exclusively on LCNEC
. Early recognition and surgical resection of these tumors remains the mainstay of treatment.
Ki-67 might be still useful in the differential diagnosis between carcinoid tumors and high-grade NEC of the lung such as small cell carcinoma and LCNEC
, especially in small biopsy specimens with crush artifacts.
Also, 4 LCNECs
with unusual clinical features were subjected to both non-NGS and Ion AmpliSeq Cancer Panel testing and showed a total of 11 genomic alterations (mean, 2.7; range, 1-4), only detected by the Ion AmpliSeq Cancer Panel.
A high Ki67 proliferation index can be very useful to differentiate carcinoids from SLCL and LCNEC
. Ki-67 proliferation index is usually up to 5% in typical carcinoid, up to 20% in atypical carcinoid, 50% to 100% in SCLC, and 40% to 80% in LCNEC