Page 153 - Read Online

Ieni et al. Colonic metastasis by a uterine LCNEC

poorly differentiated neuroendocrine carcinomas, the abdomen from the transverse colon to the pelvis,
transcription factors are expressed irrespectively of infiltrating the small intestine, the anterior parietal
primary neoplastic site, causing diagnostic problems. [5] and prevesical peritoneum, the sigmoid colon and
proximal rectum. The small intestine was disease
We report a case of a large cell neuroendocrine free for about 160 cm, being dislocated in the left
carcinoma (LCNEC), initially developed in uterus and upper quadrant. Surgeons isolated the lesion from
clinically silent, with an unusual colonic metastatic the retroperitoneal structures and then removed en
localization during the progression of the disease. bloc the tumor, the small intestine, a small portion of
the residual transverse colon, the sigmoid colon, the
CASE REPORT proximal rectum, the uterus, the uterine annexes,
pelvic and anterior parietal peritoneum [Figure 1].
A 78-year-old female patient arrived in our practice Finally, reconstruction of the digestive tract was
complaining of progressive abdominal increase and performed by creating a mechanical termino-lateral
presenting a clinical picture of intestinal obstruction. ileo-transverse anastomosis and terminal colostomy.
Her past medical history was characterized by an Postoperatively the patient was admitted to the
episode of intestinal perforation six months before in intensive care unit for 7 days. Gastrografin enema,
another hospital including right hemicolectomy. The performed on the 8th post-operative day to control the
histopathological examination of the surgical specimen ileo-colic anastomosis, demonstrated the absence of
suggested a poorly differentiated adenocarcinoma any leakage. Three months later the patient was alive,
with serosal invasion (T4) and lymph node metastases but was subsequently lost to follow-up.
(N1). The patient received 5 successive cycles of
chemotherapy and underwent a follow-up examination. Representative surgical specimens taken from uterus,
Six months later she was admitted to our hospital; colon, peritoneum and small intestine were fixed
at physical examination, the abdomen appeared in 10% buffered formaldehyde for 24 h, completely
distended, moderately painful with the presence of sampled, routinely processed and paraffin-embedded
a mass of hard consistency. Tumor markers were at 56 °C. Four micron thick sections were cut and
normal. The patient underwent an abdominal computed routinely stained with haematoxylin and eosin.
tomography scan showing a large hypodense pelvic Immunohistochemical stainings were performed with
mass of 21 cm × 15 cm × 19 cm, with peritoneal DAKO Link 48 automated system (DakoCytomation,
implants, which caused an important distortion and Copenhagen, Denmark) using commercially obtained
lateral deviation of the uterus and bladder. Regional mono-or polyclonal antibodies [Table 1].
lymph nodes were enlarged. The patient underwent
debulking surgery. A large neoplastic mass occupied Microscopically the mass appeared to have developed

Table 1: Source, working dilution and immunostainings regarding the panel of utilized antisera
Antibody Clone and dilution Company Staining
SMA 1A4, w.d. 1:100 DakoCytomation, Copenhagen, Denmark -
Calretinin DAK Calret 1, w.d. 1:50 DakoCytomation, Copenhagen, Denmark -
CD10 56C6, w.d.1:80 DakoCytomation, Copenhagen, Denmark -
CD56 123C3, w.d. 1:50 DakoCytomation, Copenhagen, Denmark -/+
CD117 C-kit, 1:400 DakoCytomation, Copenhagen, Denmark -
CK AE1/AE3, w.d. 1:50 DakoCytomation, Copenhagen, Denmark -
CK 7 OV-TL 12/30, w.d. 1:50 DakoCytomation, Copenhagen, Denmark -
CK 20 Ks 20.8, w.d. 1:50 DakoCytomation, Copenhagen, Denmark -
CDX2 DAK-CDX2, w.d. 1:50 DakoCytomation, Copenhagen, Denmark -
Chromogranin A DAK-A3, w.d. 1:200 DakoCytomation, Copenhagen, Denmark ++
Desmin D33, w.d. 1:100 DakoCytomation, Copenhagen, Denmark -
EMA E29, w.d. 1:100 DakoCytomation, Copenhagen, Denmark -/+
ER 1D5, w.d. 1:50 DakoCytomation, Copenhagen, Denmark +++
Ki67 MIB-1, w.d. 1:75 DakoCytomation, Copenhagen, Denmark 80%
MLH1 G168-728, w.d. 1:100 Cell Marque, Rocklin, California, USA ++
MSH2 G219-1129, w.d. 1:100 Cell Marque, Rocklin, California, USA ++
MSH6 SP93, w.d. 1:50 Cell Marque, Rocklin, California, USA ++
PAX-8 EP298, w.d. 1:500 Cell Marque, Rocklin, California, USA -
PgR PgR 636, w.d. 1:50 DakoCytomation, Copenhagen, Denmark -/+
S100 Polyclonal, w.d. 1:50 DakoCytomation, Copenhagen, Denmark -
Synaptophysin DAK-SYNAP, w.d. 1:50 DakoCytomation, Copenhagen, Denmark ++
Vimentin V9, w.d. 1:50 DakoCytomation, Copenhagen, Denmark -
CK: cytokeratin; EMA: epithelial membrane antigen; ER: estrogen receptor; PgR: progesteron receptor; CD56: neural cell adhesion
molecules; CD117: tyrosine chinase receptor; CDX2: caudal-related homeobox transcription factor; MLH1: MutL homolog 1 colon cancer,
non polypois type 2; MSH2: human homolog of the Escherichia Coli mismatch repair gene mutS; MSH6: protein similar to the MutS protein;
PAX-8: protein member of the paired box family of transcription factors; SMA: smooth muscle actin; S100: protein S-100; w.d.: work dilution
Journal of Cancer Metastasis and Treatment ¦ Volume 3 ¦ August 16, 2017 145