PMC3339794_01
(a) HE stain observed at 100x showing small cell carcinoma (b) 1-4. Immunohistochemistry of the tumor shown in A observed at 200x (b1). CK in dot spot (b2). Ki67 (b3). TTF1 (b4). CD56
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F1
Immunohistochemistry confirmed the diagnosis, with CD56+, CK in paranuclear spot, Ki-67 100% and TTF-1+ [Figure 1].
Pelvic CT scan with contrast. T = tumor, B = bladder, R = rectum, C = per-urethral catheter. Arrows indicate left and right ureter
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F2
Even though the tumor widely invaded both ureters [Figure 2], no hydroureteronephrosis was observed and kidney function was normal (creatinine 1.30 mg/dl).
Evolution of neuroendocrine markers
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F3
A 2537.8 ng/ml, NSE 214.5 ng/ml) [Figure 3]. After the second chemotherapy cycle, a kidney ultrasound scan showed bilateral hydronephrosis with renal insufficiency (creatinine 4.50 mg/dl) and a nephrostomy was therefore positioned.