Diagnostic Challenges and Long-term Outcomes of Neuroendocrine Carcinoma of the Cervix: A Case Series

Large-Cell Neuroendocrine Carcinoma of the Cervix: Case Report and Literature Review

Background and clinical significance: Large-cell neuroendocrine carcinoma (LCNEC) of the cervix is considered a rare type of cancer: it represents <1% of invasive cervical cancers. The optimal treatment protocol is not fully established because of its rarity and diagnostic challenges. Case Presentation: A 72-year-old Asian female presented to our outpatient clinic with postmenopausal vaginal spotting for 1 month. Vaginal sonography revealed a cervical tumor of 2.7 cm in diameter with hypervascularity. Tumor markers such as CA 125, CA 19-9, carcinoembryonic antigen, and squamous cell carcinoma antigen all showed no abnormality. Due to high suspicion of cervical cancer, a pap smear and endocervical curettage were performed and confirmed the diagnosis of LCNEC. A positron emission tomography-computed tomography scan demonstrated a glucose hypermetabolic lesion in the mid-pelvic region, localized to the uterus, consistent with LCNEC. Surgery with radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymph node dissection was performed. The patient was finally diagnosed with pT1b2N1mi, FIGO IIIC1. Immunohistochemical stain shows that the neoplastic cells were CK (+), p63 (-), p16 (-), CEA (-), vimentin (-), ER (-), WT-1 (-), p53 (-), and CD56 (+), with a high Ki67 index (75%). Concurrent chemotherapy with cisplatin and radiotherapy was performed. Four cycles of etoposide and cisplatin were planned. A 3-month follow-up of this patient revealed stable tumor marker levels. Conclusions: This case highlights the diagnostic challenges and aggressive nature of LCNEC of the cervix, emphasizing the need for a standardized treatment approach to improve patient outcomes.

Two cases of mixed large cell neuroendocrine carcinoma and adenocarcinoma of the cervix: case report and review of the literature

BACKGROUND

Mixed adenoneuroendocrine carcinoma (MANEC) of the cervix is a rare malignant tumor with high malignancy and poor prognosis, of which large-cell neuroendocrine carcinoma and HPV-independent adenocarcinoma are particularly rare, which have been reported limitedly in the literature. Here, we present 2 cases of MANEC of the cervix and discuss important considerations for diagnosing cervical poorly differentiated carcinoma.

CASE PRESENTATION

we reported two cases of mixed large cell neuroendocrine carcinoma and adenocarcinoma of the cervix, one HPV-independent and one HPV-associated, both with vaginal bleeding. Magnetic resonance imaging showed a mass-like shadow in the cervix, with varying degrees of invasion into the vagina or the lower part of the uterine body. Histologically, the tumors showed two components: solid and glandular areas, with solid areas containing nests of tumor cells and focal necrosis. In the glandular area, one showed gastric-type glandular changes, while the other showed usual-type glands. The solid area expressed CgA (1/2), Syn (2/2), and the glandular area expressed p16 (1/2), Muc-6 (1/2), MSH2 (1/2).

CONCLUSION

We made a diagnosis of mixed adenoneuroendocrine carcinoma (MANEC) of the cervix and performed a literature review to better supplement epidemiological data and assist in developing standardized treatment methods.