PMC3283836_01
Radiological findings. (A, B) Chest CT revealed a peribronchial tumor in the S6 of the left lung and bulky mediastinal lymphadenopathy. The arrow indicates the lymphadenopathy in the left chest wall. (C) During post-chemotherapy follow-up, pelvic CT revealed a massive tumor in the prostate. (D) PET/CT demonstrated marked FDG uptake (SUVmax=19.0) in the prostatic tumor.
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F1
Chest computed tomography (CT) revealed a tumor extending along the bronchus in the S6 region of the left lung, mediastinal lymphadenopathy, and a mass in the left chest wall (Figure 1A and 1B). Chest CT showed swollen mediastinal lymph nodes, and pelvic CT revealed a massive tumor in the prostate (Figure 1C). PET/CT showed FDG uptake in the mediastinal lymph node and in the prostatic tumor (Figure 1D).
Time course of serum NSE and ProGRP levels. Serum NSE and ProGRP levels decreased in response to the first-line chemotherapy, but 4 months after the chemotherapy they rose again. Gray boxes under the graph indicate the duration of chemotherapy. The abscissa is graduated in months.
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F2
The tumor marker NSE level (institutional cutoff value, 15.0 ng/mL) was elevated to 81.0 ng/mL, and ProGRP (institutional cutoff value, 46.0 pg/mL) to 346 pg/mL (Figure 2). The patient received four courses of carboplatin and etoposide combination chemotherapy, achieving a complete response, with a normalization of NSE and ProGRP (Figure 2). The tumor markers NSE and ProGRP were re-elevated to 54.5 ng/mL and 1,260 pg/mL, respectively (Figure 2), but the PSA was normal.
Histology of a neck lymph node biopsy specimen. (A) Histologically, solid nests with peripheral palisading were observed. (B) The nuclear chromatin ranges from fine to vesicular and many cells have small nucleoli. (C-E) On immunohistochemical staining, the tumor cells were positive for cytokeratin AE1/3, TTF-1, and N-CAM, respectively (C, cytokeratin AE1/3; D, TTF-1; E, N-CAM).
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F3
Histologically, right cervical lymph node biopsy revealed solid nests of large tumor cells with finely granular chromatin and small nucleoli (Figure 3A and 3B). On immunostaining, the tumor cells were positive for cytokeratin AE1/3, thyroid transcription factor (TTF)-1 and N-CAM, leading to a diagnosis of metastasis of pulmonary LCNEC (Figure 3C, 3D and 3E).
Histology of a prostate biopsy specimen. (A) The tumor cells proliferated in solid nests between the normal prostate tissues. (B) Tumor cells display fine chromatin and small nucleoli. (C-E) On immunohistochemical staining, the tumor cells were positive for cytokeratin AE1/3, TTF-1, and N-CAM, respectively (C, cytokeratin AE1/3; D, TTF-1; E, N-CAM).
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F4
Histologically, the biopsy specimen showed tumor cell infiltration between normal prostate tissue and an absence of prostatic intraepithelial neoplasia in the adjacent glands (Figure 4A). The tumor grew in solid organoid nests consisting of polygonal tumor cells with abundant, finely granular chromatin and small nucleoli (Figure 4B). TTF-1 and N-CAM (Figure 4C, 4D and 4E). These findings are similar to those of the neck lymph node biopsy specimen, leading to a diagnosis of prostatic metastasis of pre-existing lung cancer.