case_images: PMC11327133_01
case_images: PET-CT. (A) High metabolic wall occupation in the left posterior wall of the bladder. (B) High metabolic wall occupation near the upper margin of the bladder body.
case_images: fonc-14-1369649-g001.jpg
case_images: PMC11327133_01_fonc-14-1369649-g001.jpg
case_images: f1
case_images: PET-CT indicated: "The bladder body has a high metabolic wall occupying the near upper margin and the left posterior wall, which is consistent with the recurrence of bladder cancer combined with the medical history, and no clear signs of metastasis and recurrence were found" ( Figure 1 ). After completing the preoperative preparation, radical cystotomy + hysterectomy + right uretero-cutaneostomy + transurethral cystoscopy was performed under general anesthesia ( Figure 2 ):"1. (bladder) combined with immunohistochemical staining supports high-grade neuroendocrine carcinoma, considered to be a large cell neuroendocrine carcinoma, invading the muscle proper of the bladder wall, showing intravascular cancer embolus(CD31,CD34,D2-40) and nerve infiltration.
case_images: The hematoxylin-eosin (HE) and immunohistochemical pictures. (A) Bladder LCNEC cells arranged in an organoid nest growth pattern. (H&E staining, x100). (B) Bladder LCNEC cells are large, the nucleus is large, the nucleus is polymorphic, and the nucleolus is prominent (H&E staining, x400). (C) High-grade urothelial carcinoma of the bladder neck (H&E staining, x100). Immunohistochemistry: Syn (+) (D), CgA (+) (E), Ki-67 (about 70%+) (F).
case_images: fonc-14-1369649-g002.jpg
case_images: PMC11327133_01_fonc-14-1369649-g002.jpg
case_images: f2
case_images: After completing the preoperative preparation, radical cystotomy + hysterectomy + right uretero-cutaneostomy + transurethral cystoscopy was performed under general anesthesia ( Figure 2 ):"1. (bladder) combined with immunohistochemical staining supports high-grade neuroendocrine carcinoma, considered to be a large cell neuroendocrine carcinoma, invading the muscle proper of the bladder wall, showing intravascular cancer embolus(CD31,CD34,D2-40) and nerve infiltration.
case_images: Treatment timeline of this case.
case_images: fonc-14-1369649-g003.jpg
case_images: PMC11327133_01_fonc-14-1369649-g003.jpg
case_images: f3
case_images: The treatment timeline for this patient is summarized in  Figure 3 .