PMC3130460_01
Magnetic resonance imaging showing the right frontal mass as a ring-enhancing lesion on T1-weighted imaging with gadolinium contrast enhancement
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F1
Magnetic resonance imaging (MRI) of the head demonstrated a mass lesion, 4 cm in diameter, in the right frontal lobe with surrounding edema; the ring-enhancing lesion was strongly enhanced by gadolinium contrast on T1-weighted imaging [Figure 1].
Contrast-enhanced computed tomography showing the tumor in the left lateral wall of the urinary bladder with small calcification (a) and enlarged lymph node of carina tracheae (arrow) (b)
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F2
Subsequent computed tomography (CT) of the chest, abdomen and pelvis revealed a suspicious lesion in the left lateral wall of the urinary bladder with small calcifications and an enlarged lymph node of the carina tracheae, but no mass lesions in the lung fields [Figure 2].
Microscopic findings of metastatic brain large cell neuroendocrine carcinoma. Neoplastic cells showing a sheet-like growth with trabecular and rosette-like patterns (a, b). Tumor cells demonstrating abundant cytoplasm, frequent salt-and-pepper like nuclear chromatin and numerous mitotic figures (H and E: a, x100; b, x200). Tumor cell expression of CD56 (c), chromogranin A (d), synaptophysin (e) and TTF-1 (f) (x200)
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F3
Histological examination of the brain specimen revealed metastatic LCNEC characterized by diffuse proliferation of large atypical cells with coarse nuclear chromatin and frequent nucleoli [Figure 3a, b]. The carcinoma cells expressed CD56, chromogranin A, synaptophysin and thyroid transcription factor-1 (TTF-1) [Figure 3c-f].
Microscopic findings of primary urinary large cell neuroendocrine carcinoma. Large tumor cells have abundant cytoplasm with large nuclei, vesicular nuclear chromatin, and prominent nucleoli (a) (H and E, x200). Tumor cell expression of chromogranin A (b), synaptophysin (c) and TTF-1 (d) (x200)
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F4
Histological and immunohistochemical examination revealed LCNEC, the same findings as the brain specimen [Figure 4].