Small Cell Carcinoma of the Cervix: A Retrospective Clinicopathologic Analysis Over a Period of 3 Years in a Referral Laboratory in India

Abstract

Small cell neuroendocrine carcinoma of the cervix is rare, constituting less than 2% of all invasive cervical malignancies. It has a poor prognosis due to aggressive clinical course with high propensity for nodal and distant metastasis leading to mortality. Although it is known to be a chemosensitive tumor, till date no definite treatment modality has been entirely successful. Six cases diagnosed as small cell carcinoma of cervix over a period of 3 years were included in the study. Formalin-fixed paraffin-embedded tissue was subjected to hematoxylin and eosin (H&E) staining and microscopic examination. This was followed by a panel of immunohistochemical markers including synaptophysin, chromogranin, non-specific enolase (NSE), cytokeratin (CK), CD56 and Ki67 essential for diagnosis. The clinical and morphological profile in all the cases was then evaluated. Out of total 265 cervical malignancies reported, six cases (2.3%) were diagnosed as small cell carcinoma. The median age at the time of diagnosis was 49 years (range 28–67 years). All patients presented with irregular vaginal bleeding, with or without lower abdominal pain. Radiological scans revealed a mass in the cervix. Histopathological examination revealed a tumor arranged in diffuse sheets exhibiting high N/C ratio and stippled chromatin. Immunohistochemical markers employed were positive for CK, synaptophysin, chromogranin and NSE and negative for p40, CK5/6 and CD45 in all the cases. Small cell carcinoma of cervix is a rare malignancy. Because of the high rates of nodal involvement even with early-stage disease, multimodality treatment with radiotherapy and chemotherapy should be considered.