Neuroendocrine tumors of the lung with proposed criteria for large-cell neuroendocrine carcinoma. An ultrastructural, immunohistochemical, and flow cytometric study of 35 cases.
A 27-year-old man with a five pack year history of cigarette smoking presented with complaints of five months of progressively worsening shortness of breath (SOB), cough and watery diarrhea. During this period, he was treated three times as outpatient for presumed pneumonia. His cough and SOB slightly improved with each pneumonia treatment, but symptoms continued to recur. He continued to have watery diarrhea 8–10 times per day over a 5 month period. Two months prior to admission, he was evaluated in the emergency department near his home for worsening diarrhea but was sent home without any interventions when his stool studies came back negative for infectious etiology. At presentation to our facility, the patient complained of worsening productive cough with greenish sputum and diarrhea associated with abdominal cramping and urgency. Additional review of systems was significant for subjective fevers, night sweats, hemoptysis and flushing episodes. He denied weight loss, nausea, vomiting, or chest pain. He denied history of incarceration or any known tuberculosis exposure. He had a history of 2 to 3 half pints per day of alcohol intake for 10 years, but he quit drinking 8 months prior to current admission. He denied IV drug abuse. He was living in a halfway home to recover from his substance abuse. Family history was significant for Head and neck cancer in his father and type 2 diabetes mellitus in his mother. He was not taking any medications at the time of admission.