Introduction: This is a case of R.B, a 71 year old female presenting with 2months history of anorexia and weight loss associated with shortness of breath. Ct scan revealed speculated nodular lesion left upper lobe. CT guided biopsy which showed Squamous Cell Carcinoma poorly differentiated. Patient underwent exploratory thoracotomy with left lobectomy. Metastatic work up such as Bone scan and Ct scan of the abdomen were negative for metastatic spread. Histopathology of tumor specimen revealed a combined tumor: Large cell carcinoma with focal neuroendocrine differentiation (CEA negative and NSE positive. Adenocarcinoma moderately differentiated (CEA positive and NSE negative, Mucicarmine positive).
Discussion: Large cell neuroendocrine carcinoma (LNEC) is a rare and aggressive neoplasm of lung with a very poor prognosis. It accounts for approximately 1.6-3.1% of all lung cancers. Overall incidence of Large cell neuroendocrine carcinoma (LNEC) ranges from 2.1-3.1% as reported in case series and even presents with a smaller percentage for the mixed or combined type. Chest pain is the most common presentation. Local data of its true incidence is unknown since there is no existing registry for such tumors. Immunohistochemistry is seldom routinely performed in other institutions. Thus, after an intensive search no prior study was found.
Conclusion: Diagnosis of LCNEC is often difficult, and requires histological analysis, cytological evaluation and immunohistochemistry. Prognosis of LCNEC is poor, the 5-year overall survival rate for LCNEC at 27% and 21%, Treatment is similar to small cell carcinoma ,however, no standard adjuvant therapy regimen has been developed.