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Combined Large Cell Neuroendocrine Carcinoma of the Lung

Minesh Kooblall, Stephen Crowther, Eddie Moloney and Stephen Lane

We report the case of a 74 year old man, non-smoker who presented with a 3 months history of weight loss and nausea. Apart from an irregular pulse, clinical examination was normal. Blood biochemistry revealed an elevated alkaline phosphatase with hypercalcemia. CXR showed right lower lobe pleural thickening. CT Thorax/Abdomen/ Pelvis followed by a PET scan revealed 4.2 cm right lower lobe mass with FDG avid pleural, extra pleural, pancreatic and osseous lesions. Interestingly CT core biopsy of the right lower lobe showed an unusual histopathology: nonsmall cell carcinoma with acinar growth pattern consistent with adenocarcinoma and cells showing neuroendocrine features with pleomorphism CD56 positivity and chromogranin positivity in solid area. These features were suggestive of a combined large cell neuroendocrine carcinoma of the lung.