In-depth molecular analysis of combined and co-primary pulmonary large cell neuroendocrine carcinoma and adenocarcinoma

B.C.M. Hermans, J.L. Derks, Lisa M. Hillen, I. van der Baan, E.C. van den Broek, J.H. von der Thusen, R.J. Van Suylen, P.N. Atmodimedjo, T.D. den Toom, C. Coumans-Stallinga, W. Timens, W.N.M. Dinjens, H.J. Dubbink, E.J.M. Speel, A.M.C. Dingemans*, PALGA Group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Up to 14% of large cell neuroendocrine carcinomas (LCNECs) are diagnosed in continuity with nonsmall cell lung carcinoma. In addition to these combined lesions, 1% to 7% of lung tumors present as co-primary tumors with multiple synchronous lesions. We evaluated molecular and clinicopathological characteristics of combined and co-primary LCNEC-adenocarcinoma (ADC) tumors. Ten patients with LCNEC-ADC (combined) and five patients with multiple synchronous ipsilateral LCNEC and ADC tumors (co-primary) were included. DNA was isolated from distinct tumor parts, and 65 cancer genes were analyzed by next generation sequencing. Immunohistochemistry was performed including neuroendocrine markers, pRb, Ascl1 and Rest. Pure ADC (N = 37) and LCNEC (N = 17) cases were used for reference. At least 1 shared mutation, indicating tumor clonality, was found in LCNEC- and ADC-parts of 10/10 combined tumors but only in 1/5 co-primary tumors. A range of identical mutations was observed in both parts of combined tumors: 8/10 contained ADC-related (EGFR/KRAS/STK11 and/or KEAP1), 4/10 RB1 and 9/10 TP53 mutations. Loss of pRb IHC was observed in 6/10 LCNEC- and 4/10 ADC-parts. The number and intensity of expression of Ascl1 and neuroendocrine markers increased from pure ADC (low) to combined ADC (intermediate) and combined and pure LCNEC (high). The opposite was true for Rest expression. In conclusion, all combined LCNEC-ADC tumors were clonally related indicating a common origin. A relatively high frequency of pRb inactivation was observed in both LCNEC- and ADC-parts, suggesting an underlying role in LCNEC-ADC development. Furthermore, neuroendocrine differentiation might be modulated by Ascl1(+) and Rest(-) expression.
Original languageEnglish
Pages (from-to)802-815
Number of pages14
JournalInternational Journal of Cancer
Issue number5
Early online date10 Nov 2021
Publication statusPublished - 1 Mar 2022


  • Ascl1
  • pRb
  • RB1
  • Rest
  • ASCL1


Dive into the research topics of 'In-depth molecular analysis of combined and co-primary pulmonary large cell neuroendocrine carcinoma and adenocarcinoma'. Together they form a unique fingerprint.

Cite this