An unexpected case of large cell neuroendocrine carcinoma of the colon: a case report.

Background: Patients presenting with large cell neuroendocrine carcinomas (LCNECs) comprise a small minority of total colon and rectal cancers (1-2%) with poor prognostic outcomes in lieu of late diagnosis and metastasis at the point of diagnosis. Case Description: We report a case presentation of a 69-year-old male presenting with diffuse, non-severe upper abdominal pain and a positive at-home colon cancer screening test. At the time of presentation, the patient was negative for constipation or blood in stool. The patient underwent a colonoscopy with biopsy results positive for LCNEC within the proximal ascending colon. A right hemicolectomy was performed with subsequent pathology indicating a poorly differentiated LCNEC with 4/18 positive nodes and final pathology showing stage IIIA (T3, N1, M0) with Ki-67 index at 70%. Post-operative intervention included two cycles of carboplatin and etoposide as well as routine follow-up for labs, imaging, and pharmacological management. Conclusions: LCNECs are highly aggressive with poor prognostic outcomes and high mortality rates on both 1- and 5-year survival scales. Prior studies and reports indicated a need for further research and data investigating treatment standardization for patients diagnosed with LCNECs. In lieu of this, this study provides a potential standardized treatment modality combining both European Neuroendocrine Tumor Society (ENETS) and North American Neuroendocrine Tumor Society (NANETS) consensus guidelines.

Primary Breast Carcinoma of the Vulva Metastatic to Lymph Nodes and Bones: A Case Report and Literature Review.

INTRODUCTION: Primary breast carcinoma can occur at ectopic sites. The axilla is the most common site of ectopic primary breast cancer, but presentation in the vulva is rare. We discuss a rare presentation of primary breast carcinoma of the vulva with distant lymph node and bone metastases in a premenopausal woman. CASE PRESENTATION: A vulvar malignancy consistent with adenocarcinoma of the mammary gland type was diagnosed in a 47-year-old premenopausal woman. The patient underwent radical vulvectomy with bilateral superficial and deep inguinal lymphadenectomy. The tumor was positive for estrogen receptor and negative for progesterone receptor and human epidermal growth factor receptor 2/neu on immunohistochemical findings. A positron emission tomography-computed tomography scan demonstrated lymph node and bone metastases. Her disease was treated as stage IV breast cancer with metastases to the bone. Palliative treatment with ovarian suppression, aromatase inhibitor, and cyclin-dependent kinase 4/6 inhibitor was recommended. DISCUSSION: For a diagnosis of primary breast cancer of the vulva, a thorough metastatic workup should be performed, with attention directed toward detecting a breast primary disease by results of the history, physical examination, and radiologic examination of the breasts mainly to help confirm that the vulvar lesion is the primary site as opposed to metastasis from a breast primary cancer and also for staging. Management of this rare entity is challenging because of a lack of specific guidelines, and treatment, therefore, is similar to that of breast cancer.Treatment should consist of an individualized combination of surgery, radiotherapy, chemotherapy, and antiestrogen hormonal therapy.