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Have metastatic small cell carcinoma and the tumor cells express CK. What is the and the best cure?

Sep 2012
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General & Family Physician
Practicing since : 2008
Answered : 1416 Questions
My brothers wife is 35 yrs of age she has undergone biopsy of lymph node mass in the periportal region and its Microscopic Descriptions are: Metastatic small cell carcinoma. The tumor cells express CK(focally),synaptophysin,chromogranin,CD56,Mic-2(cytoplasmic),Vimentin&desmin (focally). They are immunonnegative for tdt,CD20,CD3,CD10,CD5,CD34,EMA,TTF-1&Myogenin. the Mib- proliferative index is approximately 40-50% what is this and what is the best cure

Respected sir,
As to the detailed send above, what we should do to take the right most decision for treatment we are residing in India....
Posted Sun, 25 Nov 2012 in Cancer
Answered by Dr. Das Arindam 3 hours later
Thank you for asking a question.
Small cell carcinoma can occur in many parts of our body like pituitary, lungs, breast, thyroid, pancreas, gastrointestinal tract, and many more. From any one of this areas the tumor can metastasize to any lymph node of our body.

As, the tumor cells express Synaptophysin and chromogranin, then it is more specifically called Small cell neuroendocrine tumor.

I am sorry to say but, your brother's wife is probably suffering from a carcinoma. But, Primary origin of this cancer is not known. What was her symptoms? Why the biopsy was done? You have to give me these answers as a follow up question for a better interpretation.

Now, you have to do the followings
1. First and foremost thing is contact with the laboratory for giving the slides they examined. Then review these slides from a medical college or a referral laboratory for a second opinion. Because the morphological picture is the most important thing for diagnosing a carcinoma.
2. If no definite diagnosis can not be done, then take the Paraffin blocks from the laboratory where you first submitted the tissue.
3. Go to the Tata Medical Centre , Mumbai, with the patient and the blocks. Then consult with an oncologist there for investigations like PET CT and appropriate management according to the final diagnosis.

Hope this information suffices. Let me know if you have any more question.

Above answer was peer-reviewed by
Follow-up: Have metastatic small cell carcinoma and the tumor cells express CK. What is the and the best cure? 15 hours later
pain in the stomach and the doctor said for an ultrasound and then they said for CT SCAN and the IMPRESSION are...

•     Heterogeneously enhancing mass in the GB fundus.
•     Large well defined lobulated mass lesion in the periportal region. ?lymph nodal mass. Complete encasement of the hepatic artery, main portal vein, CBD is noted. The vessel however shows normal contrast opacification.
•     Hypodense small hepatic lesion.

The imaging differentials that needs consideration are:

1.     Ca GB with large lymph nodal and a small hepatic matastasis.
2.     Lymphoma
3.     GIST

Biopsy correlation is recommended.

Nature of Material Received     :     Biopsy of a lymph node mass in the periportal region.

Histopathology Report

Gross Description          :     Multiple tiny fragments of tissue.

Microscopic Description:

Metastatic small cell carcinoma.

The tumor cells express CK (focally), synaptophysin, chromogranin, CD 56, Mic-2 (cytoplasmic), vimentin & desmin (focally).

They are immunonegative for Tdt, CD 20, CD 3, CD 10, CD 5, CD 34, EMA, TTF-1 & myogenin.

The Mib-1 proliferative index is approximately 40-50%.
Answered by Dr. Das Arindam 2 hours later
Thank you for writing back.
I have read the above history thoroughly.
In gall bladder most common tumor is adenocarcinoma. But a small cell neuroendocrine tumor is a rare condition.
So, do the review as I previously told. The commonest possibility is to be excluded first. Then presence of any other primary tumor should be excluded. In the mean time , the gall bladder is to be surgically removed and it should be sent for pathological examination. And then Chemotherapy should be started accordingly.

Or, you can directly go to Tata Medical Center as I previously told you. There, you can communicate with all the departments easily. Because, in this condition you have to take opinion from multiple discipline.

If you have your answers, close this discussion.
Rating and review given by you will be appreciated.

Above answer was peer-reviewed by
Follow-up: Have metastatic small cell carcinoma and the tumor cells express CK. What is the and the best cure? 14 hours later
what is the prognosis of this disease is it cent percent curable.....
Answered by Dr. Das Arindam 6 hours later
Thank you for writing back.
For determining prognosis, staging of the cancer is most important.
Second thing is response to chemotherapeutic agents.
So, without seeing the patient, without having all other reports like PET Scan , prognosis cannot be said.
Take care.
Above answer was peer-reviewed by
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