Understanding and Managing Bladder Large Cell Neuroendocrine Carcinoma: A Case Study and Review

Bladder large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive tumor with a poor prognosis, necessitating early diagnosis and comprehensive treatment for better outcomes, according to an article published in Frontiers in Oncology.

Primary bladder neuroendocrine carcinoma is extremely rare, comprising less than 1% of bladder tumors, with LCNEC being even rarer, with only about 50 reported cases. This malignancy is characterized by poor differentiation and strong aggressiveness, with gross hematuria being the most common symptom. Due to its rarity, no established diagnosis and treatment guidelines or expert consensus exists.

“We report a case of recurrent bladder urothelial carcinoma with LCNEC in order to improve the understanding of this disease and improve the level of diagnosis and treatment,” wrote Jiarui Cui, North China University of Science and Technology, Tangshan, Department of Urology, Hebei General Hospital, Shijiazhuang, Hebei, China, and coauthors.

A case of a 76-year-old woman initially diagnosed with severe urothelial dysplasia was presented. The patient underwent multiple treatments, including transurethral resection of the bladder tumor (TURBT), but experienced recurrent symptoms and was eventually diagnosed with high-grade urothelial carcinoma and LCNEC. Despite the recommended chemotherapy with cisplatin and etoposide, the patient refused further treatment post-surgery. Fortunately, she recovered well after radical cystectomy and remains under close follow-up with no observed metastasis or recurrence after eight months.

Bladder LCNEC's etiology remains unclear, with hypotheses suggesting origins from urinary tract stem cells or epithelium in the bladder. The diagnosis typically involves cystoscopic biopsy and pathology, supported by immunohistochemical staining. Given the aggressive nature and poor prognosis of bladder LCNEC, multimodal treatment approaches, including surgery, chemotherapy, and possibly immunotherapy, are considered essential. Studies indicate that neoadjuvant chemotherapy, especially platinum-based, improves survival rates. While the role of radical surgery versus bladder-preserving approaches remains debated, multimodal therapy is generally preferred.

Emerging genomic studies suggest potential therapeutic targets and new strategies for precision medicine in treating neuroendocrine tumors, including bladder LCNEC. Regular follow-up and monitoring are crucial due to the high risk of metastasis.

“Through the study of the bladder LCNEC genome, it may be one of the future development directions to explore the identification of early molecular markers and new targeted therapies, so as to improve diagnostic methods and multi-mode therapy, and achieve the purpose of improving prognosis,” concluded the study authors.

Reference

Cui J, Zhao Q, Yu C, Ma P, Li S. Recurrent bladder urothelial carcinoma complicated with primary bladder large cell neuroendocrine carcinoma: a case report and literature review. Front Oncol. 2024;14:1369649. doi:10.3389/fonc.2024.1369649