Abstract
Objectives: To investigate neuroendocrine carcinoma (NEC) of the uterine cervix cases for MRI features and staging, as well as pathological correlations and survival.Results: FIGO was I in 42, II in 14, III in 1, and IV in 5 patients. T2-weighted MRI showed homogeneous slightly high signal intensity and obvious restricted diffusion (ADC map, low intensity; DWI, high intensity) throughout the tumor in most cases, and mild enhancement in two-thirds. In 50 patients who underwent a radical hysterectomy and lymphadenectomy without neoadjuvant chemotherapy (NAC), intrapelvic T staging by MRI overall accuracy was 88.0% with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for metastatic pelvic lymph node detection was 38.5%, 100%, and 83.3%, respectively. During a mean follow-up period of 45.6 months (range 4.3–151.0 months), 28 patients (45.2%) experienced recurrence and 24 (38.7%) died. Three-year progression-free and overall survival rates for FIGO I, II, III, and IV were 64.3% and 80.9%, 50% and 64.3%, 0% and 0%, and 0% and 0%, respectively.Materials and Methods: Sixty-two patients with histologically surgery-proven uterine cervical NEC were enrolled. Twelve received NAC. Clinical data, pathological findings, and pretreatment pelvic MRI findings were retrospectively reviewed. Thirty-two tumors were pure NEC and 30 mixed with other histotypes. The NECs were small cell type (41), large cell type (18), or a mixture of both (3).Conclusions: Homogeneous lesion texture with obvious restricted diffusion throughout the tumor are features suggestive of cervical NEC. Our findings show that MRI is reliable for T staging of cervical NEC.
Highlights
Neuroendocrine carcinomas (NECs) of the female genital tract are aggressive uncommon tumors that usually involve the uterine cervix and ovaries, though are very rarely seen in the endometrium [1]
According to the World Health Organization (WHO) classification, neuroendocrine tumors in the uterine cervix are categorized into 4 categories; typical carcinoid, atypical carcinoid, small cell neuroendocrine carcinoma (SCNEC), and large cell neuroendocrine carcinoma (LCNEC) [2]
An LCNEC is defined as undifferentiated large cells that lack the cytologic and architectural features of small cell carcinoma, and show glandular or squamous differentiation
Summary
Neuroendocrine carcinomas (NECs) of the female genital tract are aggressive uncommon tumors that usually involve the uterine cervix and ovaries, though are very rarely seen in the endometrium [1]. A uterine cervix NEC is rare, accounting for only 1–6% of all cervical malignancies. The WHO defines SCNEC as an undifferentiated carcinoma with cellular and nuclear features that include small-sized cells, scant cytoplasm, hyperchromatic features, finely granular and molded nuclei, and inconspicuous nuclei. An LCNEC is defined as undifferentiated large cells that lack the cytologic and architectural features of small cell carcinoma, and show glandular or squamous differentiation. LCNEC is a malignant tumor composed of large cells that show neuroendocrine differentiation
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