UNILATERAL ADENOCARCINOMATOUS PLEURAL EFFUSION IN PATIENT WITH METASTATIC SMALL CELL NEUROENDOCRINE TUMOR OF CERVIX

Abstract

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Small cell neuroendocrine tumors of the cervix are rare, comprising only 2-3% of the cervical cancers. They are commonly associated with other types of epithelial tumors [1]. However, adenocarcinoma admixed with small cell neuroendocrine tumor of the cervix are extremely rare with only a handful of cases reported in the literature [2-3]. We describe a case of small cell neuroendocrine tumor of cervix diagnosed with core biopsy of the liver, who subsequently developed adenocarcinoma cells in cytology of pleural fluid. CASE PRESENTATION: This case illustrates a 51-year-old woman with metastatic small cell neuroendocrine carcinoma (SCNC) of the cervix with extensive hepatic, nodal and skeletal metastatic lesions. The SCNC diagnosis was established with a core biopsy of the liver and chemotherapy was initiated with a regimen involving Carboplatin and Etoposide along with immunotherapy (Nivolumab). The patient subsequently developed increasing dyspnea prompting further evaluation with computed tomography (CT) of the chest that revealed a unilateral pleural effusion (Image 1). Diagnostic thoracentesis performed due to suspicion for pleural infection versus drug/immunotherapy-related pleuritis. Surprisingly, cytology from the pleural fluid revealed adenocarcinoma (Image 2); tumor with markedly different morphology from original SCNC of the cervix. The patient later developed brain metastasis and opted for palliative care. DISCUSSION: Adenoneuroendocrine carcinoma of the cervix is a rare and aggressive form of malignancy that includes both neuroendocrine and exocrine components [3]. Primary small cell neuroendocrine tumors of the cervix are shown to coexist with squamous cell carcinoma of cervix and adenocarcinoma of the cervix [1]. Therefore, core or needle biopsy of these lesions may miss or only reveal one type of tumor cell morphology during sampling. This patient was only found to have a second and different tumor cell morphology on subsequent pleural fluid cytology. The patient had a negative CT of the chest without any identifiable lung mass, making second cancer unlikely. This case denotes the importance of diagnostic studies on unilateral pleural effusion which revealed surprisingly different morphology of cancer cells. CONCLUSIONS: Small cell neuroendocrine carcinoma of the cervix can be admixed with other exocrine tumors. The small cell carcinoma usually determines the prognosis of patients with cervical composite tumors. Because of the frequent presence of co-existing tumors and rarity of these tumors, it is important to examine the cervical biopsy specimens carefully and maintain a high degree of clinical suspicion for the presence of multiple morphological types. Timely identification of all subtypes is essential as the prognosis and treatment are determined based on the more aggressive subtype. Reference #1: Li, P., J. Ma, X. Zhang, Y. Guo, Y. Liu, X. Li, D. Zhao, and Z. Wang. "Cervical Small Cell Carcinoma Frequently Presented in Multiple High Risk Hpv Infection and Often Associated with Other Type of Epithelial Tumors.” Diagn Pathol 13, no. 1 (May 22 2018): 31 Reference #2: Duzkoylu, Y., O. Aras, E. B. Bostanci, T. Keklik Temucin, and M. Ulas. "Mixed Adeno-Neuroendocrine Carcinoma; Case Series of Ten Patients with Review of the Literature.” Balkan Med J 35, no. 3 (May 29 2018): 263-67. Reference #3: 2. Fadiloglu, E., A. Karalok, O. Turkmen, S. Asilturk, R. Ocalan, N. Boran, H. Okten, T. Turan, and G. Tulunay. "Amphricrine Carcinoma of the Cervix-Adeno Neuroendocrine Tumor: A Case Report.” Turk J Obstet Gynecol 13, no. 2 (Jun 2016): 99-102. DISCLOSURES: No relevant relationships by Arun Agrawal, source=Web Response No relevant relationships by Paul Buttars, source=Web Response No relevant relationships by Robert Cheney, source=Web Response No relevant relationships by Armin Krvavac, source=Web Response