SURGICAL PATHOLOGY OF ENDOCRINE AND ...

24 S. Logani and Z.W. Baloch
Fig. 5 Large cell
neuroendocrine carcinoma of
the cervix. The tumor cells show
high-grade nuclei, nuclear
molding, and can be mistaken
for high-grade squamous
intraepithelial lesion (A, Liquidbased
preparation,
Papanicolaou stain, 60 ). The
corresponding histologic
section shows the
neuroendocrine features of the
tumor (B, hematoxylin and
eosin staining, 60 ).
Immunohistochemical staining
with neuroendocrine markers
shows strong, diffuse expression
(C, synaptophysin, 60 )
neuroendocrine differentiation. Small cell and large cell
neuroendocrine carcinomas can express TTF-1 and thus
this stain is not helpful in excluding the possibility of a
lung primary metastatic to cervix. In all cases therefore, it
is imperative that a clinicopathologic correlation to
exclude the possibility of a metastatic tumor be performed
before ascribing a diagnosis of primary neuroendocrine
carcinoma of the cervix. HPV DNA can be detected in the
vast majority of neuroendocrine carcinoma of the cervix
and thus helpful in supporting a primary origin in the
cervix [32, 33].
Endocrine Tumors of the Male Genitourinary
Tract
The following neuroendocrine tumors occur in the male
genitourinary tract [26, 34]
a) Small cell and large cell neuroendocrine carcinomas of
the urinary bladder
b) Small cell carcinoma of the prostate
c) Carcinoid tumor of the testes
Neuroendocrine tumors of the prostate [35] and testes
are unlikely to be encountered in cytology practice,
and therefore, in the uncommon situation that an FNA
is performed of a testicular mass, knowledge of the cytomorphologic
features of endocrine tumors should permit a
a
c
b
correct diagnosis. Due to the rarity of primary neuroendocrine
tumors in these organs, the possibility of a metastasis
should be considered and clinically excluded. Neuroendocrine
tumors of the urinary bladder may potentially present
in voided urine samples or bladder washings [36, 37].
The diagnosis may be challenging and in the absence of a
Fig. 6 Small cell neuroendocrine carcinoma of the urinary bladder.
The tumor cells in a bladder washing specimen can be difficult to
distinguish from conventional urothelial carcinoma. The presence
of nuclear molding and lack of prominent nuclei can be helpful in
suspecting this diagnosis on a urine sample (Millipore Filter, Papanicolaou
staining, 40 )