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      De novo purely prostatic large-cell neuroendocrine carcinoma with thyroid and adrenal metastases

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          Abstract

          Summary

          Large-cell neuroendocrine carcinoma (LCNEC) is a rare neuroendocrine prostatic malignancy. It usually arises after androgen deprivation therapy (ADT), while de novo cases are even more infrequent, with only six cases described. The patient was a 78-year-old man with no history of ADT who presented with cervical lymphadenopathy. Diagnostic approaches included PET/CT, MRI, CT scans, ultrasonography, biopsies, and cytological and immunohistochemical evaluations. Results showed a poorly differentiated carcinoma in the thyroid gland accompanied by cervical lymph node enlargement. Thyroid surgery revealed LCNEC metastasis to the thyroid gland. Additional metastases were identified in both the adrenal glands. Despite appropriate treatment, the patient died of the disease. De novo LCNEC of the prostate is a rare, highly aggressive tumor with a poor prognosis. It is resistant to most therapeutic agents, has a high metastatic potential, and is usually diagnosed at an advanced stage. Further studies are required to characterize this tumor.

          Learning points

          • De novo LCNECs of the prostate gland can metastasize almost anywhere in the body, including the thyroid and adrenal glands.

          • LCNECs of the prostate are usually associated with androgen-depriving therapy, but de novo cases are also notable and should be accounted for.

          • Further studies are required to fully understand and treat LCNECs more effectively.

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          Most cited references8

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          Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients.

          L Bubendorf, A Schöpfer, U. Wagner … (2000)
          The prognosis of prostate cancer is mainly determined by the presence or absence of metastases. Nevertheless, the metastatic pathways in prostate cancer are not entirely understood. Among 19,316 routine autopsies performed from 1967 to 1995 on men older than 40 years of age, the reports from those 1,589 (8.2%) with prostate cancer were analyzed. Hematogeneous metastases were present in 35% of 1,589 patients with prostate cancer, with most frequent involvement being bone (90%), lung (46%), liver (25%), pleura (21%), and adrenals (13%). Several lines of evidence suggested the existence of a backward metastatic pathway through veins from the prostate to the spine in addition to classical hematogeneous tumor spread via the vena cava. First, there was an inverse relationship between spine and lung metastases, suggesting that metastasis to the spine is independent of lung metastasis. Second, the maximum frequency of spine involvement occurred in smaller tumors (4 to 6 cm) as compared with the maximum spread to lung (6 to 8 cm) and liver (>8 cm), suggesting that spine metastases precede lung and liver metastases in many prostate cancers. Third, there was a gradual decrease in spine involvement from the lumbar to the cervical level (97% v 38%), which is consistent with a subsequent upward metastatic spread along spinal veins after initial lumbar metastasis. The results of this study show that bone, lung, and liver are the most frequent sites of distant prostate cancer metastases. Besides the cava-type of metastasis through lung passage, there are strong arguments for the existence and clinical significance of a backward venous spread to the spine, which is likely to occur early in the metastatic process.
          Article 0 comments Cited 511 times – based on 0 reviews     Review now
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            Measurement of prostate-specific antigen in serum as a screening test for prostate cancer.

            W Catalona, D S Smith, T Ratliff … (1991)
            Prostate-specific antigen (PSA) is secreted exclusively by prostatic epithelial cells, and its serum concentration is increased in men with prostatic disease, including cancer. We evaluated its usefulness in the detection and staging of prostate cancer. We measured serum PSA concentrations in 1653 healthy men 50 or more years old. Those with PSA values greater than or equal to 4.0 micrograms per liter then underwent rectal examination and prostatic ultrasonography. Ultrasound-directed prostatic needle biopsies were performed in the men with abnormal findings on rectal examination, ultrasonography, or both. The results were compared with those in 300 consecutively studied men 50 or more years old who underwent ultrasound-directed biopsy because of symptoms or abnormal findings on rectal examination. Serum PSA levels ranged from 4.0 to 9.9 micrograms per liter in 6.5 percent of the 1653 men (107). Nineteen of the 85 men in this group (22 percent) who had prostatic biopsies had prostate cancer. Serum PSA levels were 10.0 micrograms per liter or higher in 1.8 percent of the 1653 men (30). Eighteen of the 27 men in this group (67 percent) who had prostatic biopsies had cancer. If rectal examination alone had been used to screen the men who had biopsies, 12 of the 37 cancers (32 percent) would have been missed. If ultrasonography alone had been used to screen these men, 16 of the 37 cancers (43 percent) would have been missed. Serum PSA measurement had the lowest error rate of the tests, and PSA measurement plus rectal examination had the lowest error rate of the two-test combinations. The combination of measurement of the serum PSA concentration and rectal examination, with ultrasonography performed in patients with abnormal findings, provides a better method of detecting prostate cancer than rectal examination alone.
            Article 0 comments Cited 253 times – based on 0 reviews     Review now
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              Large cell neuroendocrine carcinoma of prostate: a clinicopathologic summary of 7 cases of a rare manifestation of advanced prostate cancer.

              Egbert van Nes, Peter Humphrey, J. Srigley … (2006)
              Neuroendocrine (NE) differentiation in prostate cancer is typically detected by immunohistochemistry as single cells in conventional adenocarcinoma. Prostatic NE tumors, such as carcinoid or small cell carcinoma, are rare and large cell NE carcinoma (LCNEC) is described only in case reports. We identified 7 cases of LCNEC and compiled their clinicopathologic characteristics. In 6 cases, there was a history of adenocarcinoma treated with hormone therapy for a mean of 2.4 years (range: 2 to 3 y). The remaining case was de novo LCNEC. LCNEC was incidentally diagnosed in palliative transurethral resection specimens in 5 cases. The mean patient age at diagnosis with LCNEC was 67 years (range: 43 to 81 y). LCNEC comprised solid sheets and ribbons of cells with abundant pale to amphophilic cytoplasm, large nuclei with coarse chromatin and prominent nucleoli along with brisk mitotic activity and foci of necrosis. In 6 cases, there were foci of admixed adenocarcinoma, 4 of which showed hormone therapy effects. LCNEC was strongly positive for CD56, CD57, chromogranin A, synaptophysin, and P504S/alpha methylacyl CoA racemase. There was strong bcl-2 overexpression, expression of MIB1, and p53 in >50% of nuclei, focally positive staining for prostate specific antigen and prostatic acid phosphatase and negative androgen receptor staining. Follow-up was available for 6 patients, all of who died with metastatic disease at mean of 7 months (range: 3 to 12 mo) after platinum-based chemotherapy. LCNEC of prostate is a distinct clinicopathologic entity that typically manifests after long-term hormonal therapy for prostatic adenocarcinoma and likely arises through clonal progression under the selection pressure of therapy.
              Article 0 comments Cited 32 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab Case Rep
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab Case Rep
                Journal ID (hwp): EDM
                Title: Endocrinology, Diabetes & Metabolism Case Reports
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2052-0573
                Publication date (Electronic): 21 September 2022
                Publication date Collection: 2022
                Volume: 2022
                Electronic Location Identifier: 22-0301
                Affiliations
                [1 ]Department of Endocrine Surgery , ‘Euroclinic’ Hospital, Athens, Greece
                [2 ]Private Practice , Patras, Greece
                [3 ]Center for Diabetes and Endocrine Research , University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
                [4 ]PET-CT Department , Hygeia Hospital, Athens, Greece
                [5 ]Department of Pathology
                [6 ]Department of Medical Oncology , ‘Euroclinic’ Hospital, Athens, Greece
                Author notes
                Correspondence should be addressed to R D Paparodis; Email: rodis@ 123456paparodis.gr
                Author information
                http://orcid.org/0000-0003-4077-7407
                http://orcid.org/0000-0003-2804-0859
                Article
                Publisher ID: EDM220301
                DOI: 10.1530/EDM-22-0301
                PMC ID: 9782431
                PubMed ID: 36511447
                SO-VID: 1ef1c75b-a006-4c51-8f10-d15d14d400a6
                Copyright © © The authors
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License..

                History
                Date received : 18 August 2022
                Date accepted : 21 September 2022
                Categories
                Subject: Geriatric
                Subject: Male
                Subject: White
                Subject: Greece
                Subject: Adrenal
                Subject: Thyroid
                Subject: Adrenal
                Subject: Endocrine-Related Cancer
                Subject: Thyroid
                Subject: Tumours and Neoplasia
                Subject: Oncology
                Subject: Surgery
                Subject: Urology
                Subject: Unique/Unexpected Symptoms or Presentations of a Disease
                Subject: Unique/Unexpected Symptoms or Presentations of a Disease

                Keywords: geriatric,male,white,greece,adrenal,thyroid,endocrine-related cancer,tumours and neoplasia,oncology,surgery,urology,unique/unexpected symptoms or presentations of a disease,december,2022
                Data availability:
                Keywords: geriatric, male, white, greece, adrenal, thyroid, endocrine-related cancer, tumours and neoplasia, oncology, surgery, urology, unique/unexpected symptoms or presentations of a disease, december, 2022

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