title: Large cell neuroendocrine carcinoma of the urinary bladder: case report and review.
abstract: BACKGROUND
  Neuroendocrine carcinomas of the urinary bladder are relatively rare, accounting for less than 1% of all bladder carcinomas. These tumors can be divided into the more indolent typical or atypical carcinoid tumors and the aggressive small cell and large cell neuroendocrine carcinomas.
  
  
  OBJECTIVE
  To report 2 clinical cases of large cell neuroendocrine carcinoma of the bladder (LCCB) and to review the epidemiology, prognosis, and current treatment algorithms for patients with bladder small and large cell neuroendocrine carcinomas.
  
  
  RESULTS
  In both cases hematuria was the presenting symptom. One patient was submitted to partial cystectomy and the other to trans-urethral resection of the bladder tumor. The former patient died on the third month postoperatively. The latter patient had extensive liver metastasis at the time of diagnosis and died from acute liver failure on the 14th postoperative day. In review LCCB is associated with a more aggressive behavior and poorer prognosis than transitional cell bladder carcinoma. No standard approach exists. Surgery (transurethral ressection, partial cystectomy, radical cystectomy), chemotherapy and radiotherapy are current treatment modalities.
  
  
  CONCLUSIONS
  LCCB is an aggressive tumor which usually presents itself in an advanced stage. Neoadjuvant chemotherapy with platinum regimen plus aggressive surgical approach should be the treatment of choice.
authors.affiliation: Urology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Hugo Martins Pires
authors.initials: HM
authors.lastname: Coelho
authors.affiliation: Urology Department, Centro Hospitalar da Cova da Beira, Covilhã, Portugal.
authors.forename: Bruno Alexandre Guerra Jorge
authors.initials: BA
authors.lastname: Pereira
authors.affiliation: Urology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Paulo António Santos Temido
authors.initials: PA
authors.lastname: Caetano
keywords: Bladder cancer; Large cell neuroendocrine carcinoma; Small cell carcinoma