Laparoscopic Treatment of Large Cell Neuroendocrine Carcinoma of the Endometrium

Abstract

Abstract

Background: This article describes the presentation, identification, and laparoscopic treatment of a large-cell neuroendocrine carcinoma arising from the endometrium. Case: A para 4, 43-year-old female was referred for treatment for menorrhagia. Clinical oncology, histopathology, and pathology departments of the hospital followed her presentation, diagnosis, and management. In addition, a literature review provided a comparison of treatment modalities in this type of tumor. Results: Ultrasound revealed a 40×32×38–mm heterogenous endometrial mass, representative of a fibroid, extending from the uterine fundus. Flexible hysteroscopy supported this diagnosis, showing a smooth, white submucosal mass, which was resected hysteroscopically. Initial histology suggested an anaplastic endometrial carcinoma. The tumor was strongly estrogen-receptor–positive and progestin-receptor–positive. Testing and treatment involved laparoscopic hysterectomy, bilateral salpingo-oophrectomy, pelvic-lymph node dissection (n=20), peritoneal washings, and omental biopsy. Further histology of her resected pelvic organs did not yield evidence of malignancy. However, a second opinion on the histopathology specimens reported a primary large-cell neuroendocrine carcinoma, confirmed by positive staining with chromogranin. After diagnosis and removal of the fibroids, the patient refused adjuvant treatment. She remained well, with no signs of recurrence after 13 months and, as of this writing 24 months after diagnosis. Conclusions: An extensive literature search in MEDLINE® and EMBASE databases from 1984 to 2008 showed that neuroendocrine tumors of the uterus are rare. The vast majority of them are found in the cervix and are of the small-cell type. Only 2 cases of large-cell neuroendocrine carcinoma have been documented, as originating from the endometrium, in the last 25 years. Optimal treatment methods have not yet been established because of the rarity of this kind of tumor. (J GYNECOL SURG 27:295)