Abstract
Case summary A 97-year-old lady had a cervical biopsy for a fungating mass. The specimen showed fragments of poorly differentiated carcinoma characterised by sheets of tightly packed small cells with hyperchromatic nuclei, nuclear moulding, fine granular chromatin and scanty cytoplasm. There was no glandular or squamous differentiation. Subjacent to the tumour, there was a full thickness dysplasia consistent with cervical intraepithelial neoplasia (CIN) 3. The tumour stained for neuroendocrine markers comprising of chromogranin, synaptophysin and NSE. It was also positive for polyclonal CEA. The squamous epithelium with CIN3 stained for p16-INK4. The findings support small cell carcinoma of cervical origin. Discussion Small cell carcinoma accounts for 1–6% of cervical carcinoma. Overexpression of p16-INK4 and the presence of HPV18 E7 have been previously reported in small cell carcinoma of the uterine cervix. Therefore, inactivation of RB protein by HPV18 E7 protein is associated with carcinogenesis of small cell carcinoma. It is clinically aggressive and frequently presents with parametrial invasion and pelvic lymph node metastases. The reported 5 year survival rate is 14–39%.
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