Three case reports of ovarian neuroendocrine carcinoma

Introduction: Being very rare entities, neuroendocrine tumors of the ovary are mostly benign while few types are malignant. Based on the WHO classification, an acceptable categorization is carcinoid, atypical carcinoid, small-, and large-cell neuroendocrine carcinomas which are of low-, intermediate-, and high-grade, respectively. In this study, the authors present three cases of ovarian neuroendocrine carcinoma. Because such large-cell tumor occurs rarely, they present the similar cases which have been reported in the past. Cases: The first two cases were 71- and 56-year-old women who had been referred with an ovarian mass. Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) was performed and a Stage 1A ovarian carcinoid tumor was diagnosed in both cases. The two cases received no special type of adjuvant therapy following surgery and their disease-free survival rate was two and 14 years, respectively. The third patient was a 54-year-old woman who was referred with abdominal pain, symptoms of peritonitis, and a pelvic mass. A pelvic mass was found intraoperatively with extensive adhesions to the small and large intestines. She underwent right salpingooophorectomy and ileostomy. In pathologic study, ovarian large-cell neuroendocrine tumor and teratoma with intestinal invasion (Stage 3) were diagnosed. She received chemotherapy, then underwent TAH-LSO (TAH-left salpingo-oophorectomy) and sigmoid resection. No complication was reported in her one-year follow-up. Conclusion: Neuroendocrine tumors of the ovary may present with non-specific symptoms and diagnosis is made just based on pathologic evaluation.

Ovary; Teratoma; Large-cell neuroendocrine tumor.

[1] Rouzbahman M., Clarke B.: “Neuroendocrine tumors of the gynecologic tract: select topics”. Semin. Diagn. Pathol., 2013, 30, 224.

[2] Lopes Dias J., Cunha T.M., Gomes F.V., Callé C., Félix A.: “Neuroendocrine tumours of the female genital tract: a case-based imaging review with pathological correlation”. Insights Imaging, 2015, 6, 43.

[3] Lin C.H., Lin Y.C., Yu M.H., Su H.Y.: “Primary pure large cell neuroendocrine carcinoma of the ovary”. Taiwan J. Obstet. Gynecol., 2014, 53, 413.

[4] Gardner G.J., Reidy-Lagunes D., Gehrig P.A.: “Neuroendocrine tumors of the gynecologic tract: A Society of Gynecologic Oncology (SGO) clinical document”. Gynecol. Oncol., 2011, 122, 190.

[5] Oshita T., Yamazaki T., Akimoto Y., Tanimoto H., Nagai N., Mitao M., et al.: “Clinical features of ovarian large-cell neuroendocrine carcinoma: Four case reports and review of the literature”. Exp. Ther. Med., 2011, 2, 1083.

[6] Miyamoto M., Takano M., Goto T., Kato M., Sasaki N., Furuya K.: “Large cell neuroendocrine carcinoma arising in mature cystic teratoma: a case report and review of the literature”. Eur. J. Gynaecol. Oncol., 2012, 33, 414.

[7] Chênevert J., Bessette P., Plante M., Têtu B., Dubé V.: “Mixed ovarian large cell neuroendocrine carcinoma, mucinous adenocarcinoma, and teratoma: a report of two cases and review of the literature”. Pathol. Res. Pract., 2009, 205, 657.

[8] Veras E., Deavers M.T., Silva E.G., Malpica A.: “Ovarian nonsmall cell neuroendocrine carcinoma: a clinicopathologic and immunohistochemical study of 11cases”. Am. J. Surg. Pathol., 2007, 31, 774.

[9] Hirasawa T.: “Ovarian neuroendocrine carcinoma associated with mucinous carcinoma and teratoma”. Nihon Rinsho., 2004, 62, 973.

[10] Eichhorn J.H., Lawrence W.D., Young R.H., Scully R.E.: “Ovarian neuroendocrine carcinomas of non-small-cell type associated with surface epithelial adenocarcinomas. A study of five cases and review of the literature”. Int. J. Gynecol. Pathol., 1996, 15, 303.

[11] Ohira S., Itoh K., Shiozawa T., Horiuchi A., Ono K., Takeuchi H., et al.: “Ovarian non-small cell neuroendocrine carcinoma with paraneoplastic parathyroid hormone-related hypercalcemia”. Int. J. Gynecol. Pathol., 2004, 23, 393.

[12] Asada K., Kawana K., Teshima S., Saito A., Kawabata M., Fujii T.: “Poor prognosis of ovarian cancer with large cell neuroendocrine carcinoma: case report and review of published works”. J. Obstet. Gynaecol. Res., 2014, 40, 869.

[13] Ahmed Z., Aftab K., Kayani N.: “Ovarian primary neuroendocrine carcinoma of non-small cell type: report of an extremely rare neoplasm”. J. Pak. Med. Assoc., 2005, 55, 82.

[14] Jones K., Diaz J.A., Donner L.R.: “Neuroendocrine carcinoma arising in an ovarian mucinous cystadenoma”. Int. J. Gynecol. Pathol., 1996, 15, 167.

[15] Ding D.C., Chu T.Y., Hsu Y.H.: “Large-cell neuro-endocrine carcinoma associated with borderline mucinous tumor of the ovary”. Taiwan J. Obstet. Gynecol., 2014, 53, 270.

[16] Yasuoka H., Tsujimoto M., Fujita S., Kunishige I., Nishio Y., Kodama R., et al.: “Monoclonality of composite large cell neuroendocrine carcinoma and mucinous epithelial tumor of the ovary: a case study”. Int. J. Gynecol. Pathol., 2009, 28, 55.

[17] Sun Z., Yang J., Gou L.: “Ovarian nonsmall cell neuroendocrine carcinoma associated with increased HCG beta”. J. Clin. Pathol., 2012, 65, 375.

[18] Khurana K.K., Tornos C., Silva E.G.: “Ovarian neuroendocrine carcinoma associated with a mucinous neoplasm”. Arch. Pathol. Lab. Med., 1994, 118, 1032.

[19] Collins R.J., Cheung A., Ngan H.Y., Wong L.C., Chan S.Y., Ma H.K.: “Primary mixed neuroendocrine and mucinous carcinoma of the ovary”. Arch. Gynecol. Obstet., 1991, 248, 139.

[20] Lee J.J., Lee J.O., Lee D.H., Kim M.J., Lee D.J.: “A case of ovarian large cell neuroendocrine carcinoma”. Korean J. Obstet. Gynecol., 2012, 55, 43.

[21] Kim J.M., Shin H.C., Kim M.J.: “Ovarian large cell neuroendocrine carcinoma associated with endocervical-like mucinous borderline tumor - a case report and literature review”. Korean J. Pathol., 2011, 45, 523.

[22] Chen K.T.: “Composite large-cell neuroendocrine carcinoma and surface epithelial-stromal neoplasm of the ovary”. Int. J. Surg. Pathol., 2000, 8, 169.

[23] Draganova-Tacheva R.A., Khurana J.S., Huang Y., Hernandez E., Zhang X.: “Large cell neuroendocrine carcinoma of the ovary associated with serous carcinoma with mucin production: a case report and literature review”. Int. J. Clin. Exp. Pathol., 2009, 2, 304.

24] Choi Y.D., Lee J.S., Choi C., Park C.S., Nam J.H.: “Ovarian neuroendocrine carcinoma, non-small cell type, associated with serous carcinoma”. Gynecol. Oncol., 2007, 104, 747.

[25] Taube E.T., Denkert C., Pietzner K., Dietel M., Sehouli J., DarbEsfahani S.: “Prognostic impact of neuroendocrine differentiation in high-grade serous ovarian carcinoma”. Virchows Arch., 2015, 466, 333.

[26] Hinde E.F., Nawal H., Hannane S., Sami B., Afaf A., Abdelaziz B., et al.: “Rare tumors of ovary: case report and literature review”. Open J. Pathol., 2012, 2, 81.

[27] Tsuji T., Togami S., Shintomo N., Fukamachi N., Douchi T., Taguchi S.: “Ovarian large cell neuroendocrine carcinoma”. J. Obstet. Gynaecol. Res., 2008, 34, 726.

[28] Shakuntala P.N., Uma Devi K., Shobha K., Bafna U.D., Geetashree M.: “Pure large cell neuroendocrine carcinoma of ovary: a rare clinical entity and review of literature”. Case Rep. Oncol. Med., 2012, 2012, 120727.

[29] Behnam K., Kabus D., Behnam M.: “Primary ovarian undifferentiated non-small cell carcinoma, neuroendocrine type”. Gynecol. Oncol., 2004, 92, 372-5.

[30] Dundr P., Fischerová D., Povýsil C., Cibula D.: “Primary pure largecell neuroendocrine carcinoma of the ovary”. Pathol. Res. Pract., 2008, 204, 133.

[31] Lindboe C.F.: “Large cell neuroendocrine carcinoma of the ovary”. APMIS, 2007, 115, 169-76.

[32] Aslam M.F., Choi C., Khulpateea N.: “Neuroendocrine tumour of the ovary”. J. Obstet. Gynaecol., 2009, 29, 449.

[33] Lin C.H., Lin Y.C., Yu M.H., Su H.Y.: “Primary pure large cell neuroendocrine carcinoma of the ovary”. Taiwan J. Obstet. Gynecol., 2014, 53, 413.

[34] Ki E.Y., Park J.S., Lee K.H., Bae S.N., Hur S.Y.: “Large cell neuroendocrine carcinoma of the ovary: a case report and a brief review of the literature”. World J. Surg. Oncol., 2014, 12, 314.