Uterine cervix mixed adenoneuroendocrine carcinoma: case report of a rare, high grade and aggressive tumor

Abstract

Introduction: Neuroendocrine carcinoma of the uterine cervix is a rare type of cancer in the female reproductive system, accounting for only about 1% of all malignancies in the uterine cervix. Mixed Adenoneuroendocrine Carcinoma (MANEC) is a combination of neuroendocrine components and non-neuroendocrine components, with each component contribute >30% of the tumor cells. This rare type of tumor is aggressive, high recurrence rates, and early distant metastases.Case description: A 37-year-old female patient referred for evaluation after a previous finding of a cervix mass and a clinical diagnosis of cervical carcinoma IB2. Ultrasonography examination concluded a cervical mass, suspicious of malignancy. On macroscopic examination, it was found white-grey colored, huddle, and brittle mass filled the entire cervix with a size of 5x4 and 5x1 cm. Routine histopathological examination shows neoplastic cells forming a trabecular pattern, organoid, part with rosette formation, infiltrative between the connective tissue and a large area of necrosis. These cells conform to a uniform morphology, small oval to round nucleus, partially composed of molding, narrow cytoplasm, salt and pepper chromatin, and mitotic figure > 25/10 HPF. At some other focus, neoplastic cells appear cribriform, solid, and tubular, with a round to oval hyperchromatic nuclei, increased N/C ratio, severe nuclear pleomorphism, eosinophilic cytoplasm, mitotic figure 5/10 HPF. The metastatic cell was found in four right pelvic lymph nodes, and five left pelvic lymph nodes. Immunohistochemistry examination of chromogranin-A and CEA shows positive, focal distribution on tumor cells cytoplasms. Synaptophysin shows positive, diffuse distribution on tumors cell cytoplasm. Ki-67 was positive in 90% malignant cell nuclei.Conclusion: The result of clinical, radiological, routine histopathology, and immunohistochemical examinations support the pathological diagnosis of MANEC.