Combined large cell neuroendocrine carcinoma and spindle cell carcinoma of the lung

Mahmoud Khalifa, George Hruby, Lisa Ehrlich, Cyril Danjoux, Bayardo Perez-Ordoez

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10 Scopus citations


We report a unique case of a combined pulmonary large-cell neuroendocrine carcinoma and spindle-cell carcinoma. The patient was a 54-year-old female smoker who presented with a 4-month history of increased left-sided chest pain and exertional dyspnea. The left upper lobectomy specimen revealed an 8.0-cm mass with central necrosis. Microscopically, the epithelial areas were composed of welldefined nests of large cells with peripheral palisading expressing low-molecularweight keratin, synaptophysin, chromogranin, and neuron-specific enolase. The spindle-cell component consisted of pleomorphic cells arranged in fibrosarcoma and malignant fibrous histiocytoma-like patterns. These spindle cells were positive for low-molecular-weight keratin and vimentin with focal expression of CD68 and muscle-specific actin. Electron microscopy in the spindle-cell areas showed cell junctions and numerous tonofilaments, indicative of epithelial differentiation. The tumor behaved aggressively and the patient died with extensive metastases 4 months after surgery. The combination of neuroendocrine malignancies and spindle-cell carcinomas appears to be uncommon in the lung. Previous reports have described this association in single case reports of anaplastic small-cell carcinoma and atypical carcinoid, but not in large-cell neuroendocrine carcinoma.

Original languageEnglish (US)
Pages (from-to)240-245
Number of pages6
JournalAnnals of Diagnostic Pathology
Issue number4
StatePublished - 2001
Externally publishedYes


  • Large-cell carcinoma
  • Lung
  • Neuroendocrine carcinoma
  • Sarcomatoid carcinoma
  • Spindle-cell carcinoma


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