Unknown primary large-cell neuroendocrine tumor

Large-cell neuroendocrine tumors (NETs) are poorly differentiated malignancies of rare incidence and aggressive nature. NETs mostly arise in the lung followed by the gastrointestinal tract, although they are potentially ubiquitous throughout the body. Primary unknown NET has a worse prognosis and shorter survival comparing with other NETs, with limited available data in the literature concerning this subgroup. The authors report the case of large-cell NET with supraclavicular lymph node presentation. Total excisional biopsy revealed an enlarged adenopathy 18 × 15 × 10 mm, which was extensively infiltrated by a solid malignant neoplasm composed of large cells with granular chromatin, nuclear pseudo-inclusions, high mitotic index, and focal necrosis, with a Ki 67 index 25-30% and positive immunohistochemical study for the expression of cytokeratin 8/18, chromogranin, synaptophysin, and thyroid transcriptional factor-1 (TTF-1). There was no evidence of primary location apart from two infracentimetric lung lesions that could not be accessed for biopsy and were negative at both somatostatin receptor scintigraphy and positron emission tomography. The NET relapsed with three mediastinal masses, so the patient was started on chemotherapy with carboplatin and etoposide with initial total response. Early progression showed no response to further chemotherapy regimens (temozolomide, oral etoposide); therefore, the patient was treated with local radiotherapy. This patient has an atypical long survival (54 months) compared to the literature data. In fact, there are few long-term survivors of large-cell NET and they are all related to complete surgical resection.

Spontaneous regression of a pulmonary adenocarcinoma after core needle biopsy

Spontaneous regression (SR) of cancer, especially lung cancer, is a rare biological event with a mechanism that is not currently understood. Immunological mechanisms seem to be the stronger explanation in SR of a lung cancer. We report the rare case of SR of a lung adenocarcinoma stage IA, in a 75-year-old man, which was incidentally diagnosed and histologically confirmed. Due to the patient's comorbidities and his poor pulmonary function, stereotactic radiotherapy was scheduled. However, by the time the treatment was due to start, the tumor was no longer detectable.

Carcinoma adenóide cístico localmente avançado de traquéia tratado com radioterapia associada à quimioterapia / Locally Advanced Adenoid Cystic Carcinoma of the Trachea Treated with

Introdução: O carcinoma adenoide cístico representa o segundo tipo histológico mais frequente entre os raros tumores traqueais. Relato do caso: Paciente de 67 anos com dispneia progressiva. Tomografia de tórax mostrou formação expansiva no terço distal da traqueia cuja biópsia evidenciou carcinoma adenoide cístico primário de traqueia. O paciente evoluiu com piora do quadro respiratório, sendo encaminhado em caráter de urgência para radioterapia concomitante à quimioterapia com cisplatina, apresentando então melhora respiratória importante. Dois anos edez meses após o término do tratamento, apresentava-se sem queixas clínicas relevantes e sem toxicidades crônicas inerentes ao tratamento. Broncoscopia e tomografia de tórax não mostravam sinais de recidiva tumoral. Conclusão: Ocarcinoma adenoide cístico de traqueia tem na cirurgia sua principal modalidade terapêutica. Contudo, em pacientescom tumores irressecáveis, a radioterapia representa a principal modalidade terapêutica, podendo ser combinada à quimioterapia. O prognóstico desses tumores permanece reservado, mesmo após ressecção completa, com altas taxasde recidiva local e/ou a distância.