Primary neuroendocrine carcinoma of inguinal lymph node as a plausible entity: A case report
We report primary neuroendocrine carcinoma (NEC) of the inguinal lymph node (LN) as a plausible clinical entity. Though previously controversial and suspected to alternatively represent an atypical presentation of LN metastasis from an unknown primary, we now report the third case of isolated inguin...
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Elsevier
2023-12-01
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| Series: | Current Problems in Cancer: Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666621923000510 |
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| author | Jane Rhyu Saeed Sadeghi Jonathan C. King Steven D. Hart Jianyu Rao Run Yu |
| author_facet | Jane Rhyu Saeed Sadeghi Jonathan C. King Steven D. Hart Jianyu Rao Run Yu |
| author_sort | Jane Rhyu |
| collection | DOAJ |
| description | We report primary neuroendocrine carcinoma (NEC) of the inguinal lymph node (LN) as a plausible clinical entity. Though previously controversial and suspected to alternatively represent an atypical presentation of LN metastasis from an unknown primary, we now report the third case of isolated inguinal LN NEC. The cases strongly support this diagnosis as a separate clinical entity with indolent behavior, unlike NEC that has metastasized to the LN. Our patient was a 68-year-old female who presented with an isolated left 4 cm enlarged inguinal LN. A core needle biopsy of the mass demonstrated cores of soft tissue that were diffusely infiltrated by loosely cohesive neoplastic cells in streaming cords and clusters. The cells were hyperchromatic, enlarged, and exhibited very high nucleus to cytoplasm ratio with prominent nuclear crowding, vesicular chromatin, inconspicuous to rare nucleoli, and scant cytoplasm. Mitotic activity was robust. Immunohistochemistry staining showed positivity for synaptophysin with Ki67 >80 % but was not supportive of lymphoma or Merkel cell carcinoma. The cytological diagnosis was metastatic small cell NEC. FDG-PET/CT showed intense FDG avidity of the left inguinal LN without any evidence of potential primary malignancy or distant metastatic disease. Based on 2 previous case reports with favorable outcomes, we considered primary inguinal LN NEC as a plausible diagnosis. The patient underwent surgical resection with surgical histology confirming small cell NEC in LN, and systemic therapy and radiation therapy were held off. Postoperatively, the patient has remained disease-free for 16 months. Recognition of this clinical entity is important as it carries favorable prognosis with surgery as first line therapy. Primary inguinal LN NEC should be considered in the differential diagnosis of NECs in an inguinal LN. |
| first_indexed | 2024-03-08T23:10:41Z |
| format | Article |
| id | doaj.art-ac59d0abc873465686ec843d457d30ac |
| institution | Directory Open Access Journal |
| issn | 2666-6219 |
| language | English |
| last_indexed | 2024-03-08T23:10:41Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Current Problems in Cancer: Case Reports |
| spelling | doaj.art-ac59d0abc873465686ec843d457d30ac2023-12-15T07:26:33ZengElsevierCurrent Problems in Cancer: Case Reports2666-62192023-12-0112100267Primary neuroendocrine carcinoma of inguinal lymph node as a plausible entity: A case reportJane Rhyu0Saeed Sadeghi1Jonathan C. King2Steven D. Hart3Jianyu Rao4Run Yu5Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine, 10833 Le Conte Ave - CHS 57-145, Los Angeles, CA 90095, USA; Corresponding author.Division of Hematology and Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USADepartment of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USADepartment of Pathology, UCLA David Geffen School of Medicine, Los Angeles, CA, USADepartment of Pathology, UCLA David Geffen School of Medicine, Los Angeles, CA, USADivision of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine, 10833 Le Conte Ave - CHS 57-145, Los Angeles, CA 90095, USAWe report primary neuroendocrine carcinoma (NEC) of the inguinal lymph node (LN) as a plausible clinical entity. Though previously controversial and suspected to alternatively represent an atypical presentation of LN metastasis from an unknown primary, we now report the third case of isolated inguinal LN NEC. The cases strongly support this diagnosis as a separate clinical entity with indolent behavior, unlike NEC that has metastasized to the LN. Our patient was a 68-year-old female who presented with an isolated left 4 cm enlarged inguinal LN. A core needle biopsy of the mass demonstrated cores of soft tissue that were diffusely infiltrated by loosely cohesive neoplastic cells in streaming cords and clusters. The cells were hyperchromatic, enlarged, and exhibited very high nucleus to cytoplasm ratio with prominent nuclear crowding, vesicular chromatin, inconspicuous to rare nucleoli, and scant cytoplasm. Mitotic activity was robust. Immunohistochemistry staining showed positivity for synaptophysin with Ki67 >80 % but was not supportive of lymphoma or Merkel cell carcinoma. The cytological diagnosis was metastatic small cell NEC. FDG-PET/CT showed intense FDG avidity of the left inguinal LN without any evidence of potential primary malignancy or distant metastatic disease. Based on 2 previous case reports with favorable outcomes, we considered primary inguinal LN NEC as a plausible diagnosis. The patient underwent surgical resection with surgical histology confirming small cell NEC in LN, and systemic therapy and radiation therapy were held off. Postoperatively, the patient has remained disease-free for 16 months. Recognition of this clinical entity is important as it carries favorable prognosis with surgery as first line therapy. Primary inguinal LN NEC should be considered in the differential diagnosis of NECs in an inguinal LN.http://www.sciencedirect.com/science/article/pii/S2666621923000510Primary neuroendocrine carcinomaInguinal lymph node |
| spellingShingle | Jane Rhyu Saeed Sadeghi Jonathan C. King Steven D. Hart Jianyu Rao Run Yu Primary neuroendocrine carcinoma of inguinal lymph node as a plausible entity: A case report Current Problems in Cancer: Case Reports Primary neuroendocrine carcinoma Inguinal lymph node |
| title | Primary neuroendocrine carcinoma of inguinal lymph node as a plausible entity: A case report |
| title_full | Primary neuroendocrine carcinoma of inguinal lymph node as a plausible entity: A case report |
| title_fullStr | Primary neuroendocrine carcinoma of inguinal lymph node as a plausible entity: A case report |
| title_full_unstemmed | Primary neuroendocrine carcinoma of inguinal lymph node as a plausible entity: A case report |
| title_short | Primary neuroendocrine carcinoma of inguinal lymph node as a plausible entity: A case report |
| title_sort | primary neuroendocrine carcinoma of inguinal lymph node as a plausible entity a case report |
| topic | Primary neuroendocrine carcinoma Inguinal lymph node |
| url | http://www.sciencedirect.com/science/article/pii/S2666621923000510 |
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