small cell carcinoma


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  • Clinical

    • lung
      • smoker
      • mediastinal mass
      • paraneoplastic syndrome
      • worse prognosis if
        • extensive stage
        • poor performance
        • elevated LDH or AP
        • low albumin
        • low Na
    • uterus
      • rare, <1% of carcinoma

  • Histology

    • architecture
      • nests
      • sheets
      • trabecula
      • peripheral palisading
      • rosettes
    • small neuroendocrine cells with high NC ratio
    • nuclear moulding
    • salt and pepper chromatin

  • Stains

    • CD56+
    • chromogranin+
    • synaptophysin+
    • NSE+
    • TTF1+ (90%)

  • Molecular

    • large 3p del, often 3q isochromosome
    • p53
    • RB
    • E2F1 overexpression
    • SCLC+, NSCLC-
      • MYC amplification
      • caspase-8 methylation
    • NSCLC+, SCLC-
      • Ras mutation
      • Cox-2 overexpression

  • Ddx

    • Carcinoid
      • less necrosis, mitosis, apoptosis
    • PNET
      • CD99+
      • TTF1-
      • CK-
    • Merkel cell carcinoma
      • CK20+
      • CK7-
      • TTF1-
    • lymphoma

  • Staging

    • unlike other lung ca, this one is limited vs extensive
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