A Fatal Case of Large Cell Neuroendocrine Lung Cancer Metastatic to the Brain: A Case Report

Abstract

Large cell neuroendocrine carcinoma (LCNEC) is part of lung neuroendocrine tumors. LCNEC represents an extremely rare entity with aggressive behavior and poor prognosis. Primary surgery is the mainstream of treatment, although it is rarely amenable due to local or systemic tumor metastasis at the time of the diagnosis. We present a case report of a female patient diagnosed with large cell neuroendocrine lung cancer metastatic to the brain. Noting the low incidence of the disease, the lack of relevant clinical data has resulted in a challenge in diagnosis and management.

Keywords: brain metastasis; large cell neuroendocrine carcinoma; palliative radiation.

Figure 1. Computed tomography (CT) of the brain

Figure A (axial) and B (coronal) views represent a 2.2 cm right frontal lobe area of intraparenchymal hemorrhage with surrounding edema and mild mass effect. Figure C shows a sagittal view, revealing a right parietal lobe, large, 3.7 x 2.5 cm, hyperdense; and a smaller area within the right frontal lobe with surrounding vasogenic edema and possible related underlying mass.

Figure 2. Magnetic resonance imaging (MRI) of the brain

MRI of the brain (Figures A-C, axial view) revealed a peripherally enhancing right posterior parietal hematoma with central hypointensity and surrounding edema, along with a septated rim-enhancing focus about the right frontal lobe. Figure D represents the coronal view. Figures E-F (sagittal view) presented a redemonstration of right frontal and posterior parietal intraparenchymal hematomas.

Figure 3. Computed tomography (CT) of the lungs

Figure A: CT of the lungs demonstrated a left upper lobe 3.6 cm x 4 cm x 3.7 cm mass with adjacent smaller masses. Figures B-C redemonstrated the left mass and revealed multiple smaller nodules in the right lower, right middle, and right upper lungs.