Table of Contents
Lung Cancer International
Volume 2011 (2011), Article ID 912098, 6 pages
http://dx.doi.org/10.4061/2011/912098
Case Report

An Atypical Presentation with Diagnostic Challenge of a Large Cell Neuroendocrine Cancer of Lung: A Case Report and Review of the Literature

1Internal Medicine, Synergy Medical Education Alliance, 1000 Houghton Avenue, Saginaw, MI 48602, USA
2Pulmonary and Critical Care, Synergy Medical Education Alliance, 1000 Houghton Avenue, Saginaw, MI 48602, USA
3Hematology and Oncology, Oncology Hematology Associates of Saginaw Valley, 5400 Mackinaw Road, Suite 4200, Saginaw, MI 48604-9533, USA

Received 3 March 2011; Accepted 23 March 2011

Academic Editor: Akira Iyoda

Copyright © 2011 Pavan Kumar Bhamidipati et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Large-cell neuroendocrine carcinomas (LCNECs) are relatively rare and aggressive neoplasms of the lung with very poor prognosis. Even though they are included in the classification of nonsmall cell carcinomas, they have a biological behaviour and physiological response to treatment more like small cell carcinomas of lung. We report an atypical case presentation of LCNEC in a 51-year-old gentleman who presented with diffuse metastases to the thoracic and lumbar spine, brain, and liver, posing a diagnostic challenge. The primary small central lung tumor was in close proximity to major vessels, rendering a biopsy of the primary cancer challenging and nearly impossible. The final diagnosis was established through immunohistochemistry staining and examination of liver biopsy from a metastatic lesion. We also included a review of the current literature pertinent to LCNEC, as well as the important role of tumor markers plus immunohistochemistry profiles in determining the origin of unknown primary tumors in such difficult patient presentations.