Cervical Neuroendocrine Tumor: Rare Case Report

Abstract

Neuroendocrine carcinoma of the cervix (NECC) is a rare variant of cervical cancer. The prognosis of women with NECC is poor, and there is no standardized therapy for this type of malignancy based on controlled trials (Tempfer et al. in BMC Cancer 18:530, 2018). A case of carcinoma cervix with neuroendocrine differentiation (small-cell neuroendocrine carcinoma) was reported in a 38-year-old female patient who presented with the complaints of bleeding per vaginum and dysmenorrhea. The gynecologist had a strong suspicion of malignancy, and the cervical examination revealed a small growth measuring 1 × 0.5 cm. The patient was screened with a Pap smear, which was negative for malignancy and showed large inflammatory cells. CT revealed a cervical growth measuring 2 × 2 × 0.5 cm. A surgical specimen of utreus with enlarged cervix measuring 3 cm in diameter and growth confined up to cervix. Punch biopsy revealed sheets of round to polygonal cells of monomorphic appearance with scant cytoplasm and salt-and-pepper chromatin. Sheets of cells were separated by scanty fibrocollagenous tissue infiltrated by chronic inflammatory cells such as plasma cells and lymphocytes (Scully et al. in Int J Gynecol Pathol 3:51–70, 1984). Immunohistochemical evaluation by chromogranin and synaptophysin was done for confirmation. The final histopathologic diagnosis was high-grade neuroendocrine tumor, small-cell type (SCNC), PT1bN0M0, FIGO stage I. Radical hysterectomy, pelvic lymph node dissection and bilateral salpingo-oophrectomy were performed as primary treatment for cervical carcinoma along with adjuvant treatment with cisplatin 50 mg, paclitaxel 200 mg and etoposide 100 mg repeated for four cycles of treatment. The patient is currently symptoms free, with the side effect of grade-2 diarrhea. We concluded that the histopathologic and immunohistochemical evaluation helped us reach the correct diagnosis. The trial of cisplatin and paclitacil as chemoadjuvant therapy provided good results and was well tolerated (Zhou et al. in Transl Cancer Res 6(4):860–868, 2017). This should be helpful for future diagnosis and management of SCNC of the cervix.