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J Thorac Cardiovasc Surg 2003;125:1183-1184
© 2003 The American Association for Thoracic Surgery

Letters to the Editor

Reply

Hidefumi Takei, MD, Hisao Asamura, MD, Yoshihiro Matsunomo, MD

National Cancer Center Hospital, Tokyo, Japan

Reply to the Editor:

We appreciate the thoughtful comments by Filosso on our recent articleGo 1 describing the clinicopathologic aspects of large cell neuroendocrine carcinoma (LCNC) of the lung.

The histologic type of LCNC of the lung has been included as the subtype of large cell carcinoma in the revised World Health Organization classification of lung and pleural tumors in 1999.Go 2 The clinicopathologic features, however, have not been described in detail. Especially little is known about the response of LCNC to the chemotherapy and radiotherapy. Considering the analogy of LCNC to the small cell histologic type, a multimodal therapeutic approach might be expected to be promising.

As Filosso pointed out, we also have a great interest in the expression of somatostatin receptors in LCNC. If these receptors are expressed frequently in LCNC, octreotide scintigraphy with somatostatin analog (OctreoScan) would reasonably be of great utility in the preoperative evaluation of extent of disease of LCNC. Indeed, carcinoid tumor and small cell carcinoma have already been shown to be well analyzed by octreotide scintigraphy.Go Go 3,4 As for LCNC, however, according to a report by Jiang and colleagues,Go 5 only 9 (40.9%) of 22 cases were shown to stain positively for somatostatin, and these tumor cells do not necessarily express somatostatin receptors. Whether octreotide scintigraphy can be used depends on the rate of expression of somatostatin receptors. At present no data are available on the expression of somatostatin receptors in LCNC.

Furthermore, the preoperative establishment of a histologic diagnosis of LCNC is crucial in planning the LCNC-specific treatment strategy. However, it is actually quite difficult to get the histologic or cytologic diagnosis of LCNC simply by the evaluation of tiny preoperative biopsy specimen. Novel LCNC-specific markers ("immunohistochemically detectable") must be sought; such markers would easily enable the histologic diagnosis of LCNC.

Again, we pointed out that LCNC should be recognized as one of the poorest prognostic subgroups in lung cancer, and novel therapeutic approaches should be established. Further accumulation of clinicopathologic characteristics, especially the response to nonsurgical treatment, is the most important issue. The histologic classification of lung tumors with neuroendocrine phenotype also seems to need further revision in the near future.

References

  1. Takei H, Asamura H, Maeshima A, Suzuki K, Kondo H, Niki T, et al. Large cell neuroendocrine carcinoma of the lung: a clinicopathologic study of eighty-seven cases. J Thorac Cardiovasc Surg. 2002;124:285-92.[Abstract/Free Full Text]
  2. Travis WD, Colby TV, Corrin B, Shimosato Y, Brambilla E. Histological typing of lung and pleural tumours. 3rd ed. Berlin: Springer Verlag; 1999.
  3. Musi M, Carbone RG, Bertocchi C, Cantalupi D, Michetti G, Pugliese C, et al. Bronchial carcinoid tumors: a study on clinicopathologic features and role of octreotide scintigraphy. Lung Cancer. 1998;22:97-102.[Medline]
  4. Kwekkeboom DJ, Kho GS, Lamberts SW, Reubi JC, Laissue JA, Krenning EP. The value of octreotide scintigraphy in patients with lung cancer. Eur J Nucl Med. 1994;21:1106-13.[Medline]
  5. Jiang SX, Kameya T, Shoji M, Dobashi Y, Shinada J, Yoshimura H. Large cell neuroendocrine carcinoma of the lung: a histologic and immunohistochemical study of 22 cases. Am J Surg Pathol. 1998;22:526-38.[Medline]




This Article
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