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• W4387248116 abstract "SESSION TITLE: Lung Cancer Case Report Posters 4 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Large cell neuroendocrine carcinoma of the lung (LCNEC) is a rare tumor that represents 3% of all lung cancers. It is highly aggressive with a poor prognosis. Histologically, it exhibits similarities with both small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC). The diagnosis is complex because small biopsies are usually insufficient, and surgical lung biopsies are usually needed. Due to its rareness, established management plans are still lacking. Here, we present a case of LCNEC that was diagnosed via small biopsies from endobronchial ultrasound (EBUS) bronchoscopy. CASE PRESENTATION: A 64-year-old man presented to the emergency department complaining of two weeks of progressive dyspnea. CT scan of the chest showed a right-sided large central lung mass causing compression of adjacent structures. He was discharged home to follow up with pulmonary as an outpatient. However, one week later, he presented with worsening dyspnea, cough, and fever. A repeat CT chest redemonstrated the mass along with worsening right pleural effusion and atelectasis. He was started on antibiotics for post-obstructive pneumonia. CT-guided lung biopsy and thoracentesis cytology were negative for malignancy. An EBUS was then performed, which showed a large, endobronchial fungating mass obliterating the entrance of the right upper lobe. Cytology samples, brushings, washings, and biopsies were obtained. The initial pathology report was concerning for SCLC, and a second opinion was requested. Meanwhile, concurrent chemoradiotherapy for SCLC was started due to worsening clinical status. After pathology referral, the final report was consistent with LCNEC given the high proliferation index, neuroendocrine markers (CD 56 and synaptophysin), and morphology. Unfortunately, the patient had a sudden cardiac arrest and did not survive the admission. DISCUSSION: Although most lung cancer diagnoses can be made by small biopsies, the definitive diagnosis of LCNEC can be difficult without a large excisional biopsy or resection. The histological diagnosis of lung LCNEC depends on the presence of characteristic morphology and the expression of at least one of the neuroendocrine markers (CD56, chromogranin A, and synaptophysin), in addition to a high proliferation index. Identification of the morphology and the markers (mainly by immunohistochemical staining) is difficult to perform on small biopsies and cytology smears due to the typical crushing artifact. In our case, the patient was diagnosed with lung LCNEC after meeting the criteria on a small biopsy. CONCLUSIONS: Many pathologists feel that LCNEC cannot be made definitively on small biopsy and may require more tissue for definitive diagnosis. However, the diagnosis may be made on a small biopsy by expert pathologists. If the index of suspicion is high, a referral to an expert should be considered before proceeding with a procedure that could confer higher morbidity. REFERENCE #1: Andrini E, Marchese PV, De Biase D, Mosconi C, Siepe G, Panzuto F, Ardizzoni A, Campana D, Lamberti G. Large Cell Neuroendocrine Carcinoma of the Lung: Current Understanding and Challenges. J Clin Med. 2022 Mar 7;11(5):1461. doi: 10.3390/jcm11051461. PMID: 35268551; PMCID: PMC8911276. REFERENCE #2: Lindsay CR, Shaw EC, Moore DA, Rassl D, Jamal-Hanjani M, Steele N, Naheed S, Dick C, Taylor F, Adderley H, Black F, Summers Y, Evans M, Rice A, Fabre A, Wallace WA, Nicholson S, Haragan A, Taniere P, Nicholson AG, Laing G, Cave J, Forster MD, Blackhall F, Gosney J, Popat S, Kerr KM. Large cell neuroendocrine lung carcinoma: consensus statement from The British Thoracic Oncology Group and the Association of Pulmonary Pathologists. Br J Cancer. 2021 Oct;125(9):1210-1216. doi: 10.1038/s41416-021-01407-9. Epub 2021 Sep 6. PMID: 34489586; PMCID: PMC8548341. DISCLOSURES: No relevant relationships by Mohamad Al-Momani No relevant relationships by Rami Dalbah No relevant relationships by Ummah Salma Nisar No relevant relationships by Ahmad Othman No relevant relationships by Krupa Solanki No relevant relationships by Amanda Vanlandingham" @default.
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• W4387248116 date "2023-10-01" @default.
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• W4387248116 title "LARGE CELL NEUROENDOCRINE CANCER OF THE LUNG DIAGNOSED BY SMALL BIOPSY" @default.
• W4387248116 doi "https://doi.org/10.1016/j.chest.2023.07.2897" @default.
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