Large cell neuroendocrine carcinoma of the lung

Last revised by Kieran Kusel on 9 Apr 2023

Large cell neuroendocrine carcinoma (LCNEC) of the lung is classified as a subtype of large cell carcinoma of the lung. It is also classified as a pulmonary neuroendocrine tumor.

The incidence peaks around the 6th decade 6. There is an increased male predilection 7. They are rare and account for ∼3% of all lung cancers, although the proportion of lung cancers diagnosed as large cell neuroendocrine carcinoma may be increasing 12.

Large cell neuroendocrine carcinoma of the lung is a poorly differentiated high-grade neuroendocrine tumor 10

They have neuroendocrine morphology, neuroendocrine differentiation on immunohistochemistry, often high mitotic rates (>10 mitoses/mm2) and non-small cell cytological features 12

As with other neuroendocrine tumors of the lung, large cell neuroendocrine carcinoma arises from Kulchitsky cells of the bronchial mucosa 3.

There is a strong association with smoking 11.

CT features are non-specific. Large cell neuroendocrine carcinomas, in general, tend to present as oval-to-round and well-demarcated masses with lobulated margins. Their size typically ranges from 2 to 5 cm. Internal calcification is uncommon (9-21%) 2,4,7. A slight peripheral predilection may be present 5. There can be homogeneous or inhomogeneous enhancement following contrast 1.

They tend to be aggressive high-grade tumors with a poor prognosis 6. The overall prognosis is thought to be between that of an atypical pulmonary carcinoid and small cell lung cancer 3.

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