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Small Cell Carcinoma of the Vagina: First Systematic Review of Case Reports and Proposal of a Management Algorithm. J Low Genit Tract Dis 2023; 27:56-67. [PMID: 36282979 PMCID: PMC9770126 DOI: 10.1097/lgt.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Small cell carcinoma of the vagina (SmCCV) is an extremely rare disease. Evidence-based data and specific guidelines are lacking. We conducted the first systematic review of case reports to provide the most overall picture of SmCCV. MATERIALS AND METHODS Literature search in PubMed and Scopus was performed using the terms "small cell carcinoma" and "vagina." English-language case reports of primary SmCCV up to January 2022 were included. RESULTS Twenty-nine articles describing 44 cases met our inclusion criteria. We report a new case of our hospital. The global median overall survival (mOS) was 12.00 months (95% CI = 9.31-14.69). The mOS was not reached for stage I, and it was 12.00, 12.00, 9.00, and 8.00 months for stages II, III, IVA, and IVB, respectively (statistically significant differences between stage I and stages II, III, or IVA [log rank p = .003-.017]). Thirty-five cases received local treatments (77.8%). The mOS of patients treated with surgery ± complementary chemotherapy, radiotherapy ± complementary chemotherapy, chemoradiation ± complementary chemotherapy, and surgery + radiotherapy ± complementary chemotherapy were 11.00, 12.00, 17.00, and 29.00 months, respectively. The use of adjuvant or neoadjuvant chemotherapy (64.5%, mostly platinum + etoposide) showed longer mOS (77.00 vs 15.00 months). Four of 5 tested cases presented human papillomavirus infection, 3 of them presenting type 18. CONCLUSIONS Small cell carcinoma of the vagina shows dismal prognosis. Multimodal local management plus complementary chemotherapy seems to achieve better outcomes. Human papillomavirus could be related to the development of SmCCV. A diagnostic-therapeutic algorithm is proposed.
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Leal-Costa L, Godinho J, Simões P, Casa-Nova M. Neuroendocrine carcinoma of vagina with prolonged survival. BMJ Case Rep 2022; 15:e252031. [PMID: 36316052 PMCID: PMC9628548 DOI: 10.1136/bcr-2022-252031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report the case of a woman in her 70s with a stage IVA small cell neuroendocrine carcinoma of the vagina. The patient started chemotherapy with cisplatin and etoposide followed by concurrent chemoradiotherapy and adjuvant chemotherapy. Pelvic MRI after completion of treatment did not show residual disease. Three years and 8 months after definitive treatment, the patient remains on regular follow-up without evidence of disease.
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Affiliation(s)
| | - João Godinho
- Medical Oncology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Pedro Simões
- Medical Oncology, Hospital Beatriz Ângelo, Loures, Portugal
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3
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Pongsuvareeyakul T, Garcia-Moliner M, Lokich E, Dizon DS, Singh K. Small cell neuroendocrine carcinoma of vagina: Report of a unique case with literature review. Cancer Treat Res Commun 2022; 33:100645. [PMID: 36274474 DOI: 10.1016/j.ctarc.2022.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/12/2022] [Accepted: 10/02/2022] [Indexed: 11/27/2022]
Abstract
Small cell carcinoma (SCC) of vagina is extremely rare. The association between this tumor and high-risk HPV infection is unclear. To our knowledge, HPV status has been reported in only 3 previous cases of SCC of vagina. Herein, we present a unique case of vaginal small cell carcinoma with discordant HPV testing results between vaginal and cervical samples. We also review and discuss findings from previously reported cases of small cell carcinoma of vagina.
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Affiliation(s)
- Tip Pongsuvareeyakul
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island, United States
| | - Maria Garcia-Moliner
- Department of Pathology and Laboratory Medicine Rhode Island Hospital, Providence, Rhode Island, United States
| | - Elizabeth Lokich
- Department of Women Oncology Women & Infants Hospital of Rhode Island, Brown University, Providence, Rhode Island, United States
| | - Don S Dizon
- Department of Medicine Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Kamaljeet Singh
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island, United States.
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4
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Sabri A, Li C, Monika FNU, Sharma A, Sharma P. Primary Vaginal Adenocarcinoma of Intestinal-Type: A Case Report of a Rare Tumor With Review of Histology, Differential Diagnosis, and Literature. Cureus 2022; 14:e25298. [PMID: 35755502 PMCID: PMC9224843 DOI: 10.7759/cureus.25298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
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5
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Detka J, Głombik K. Insights into a possible role of glucagon-like peptide-1 receptor agonists in the treatment of depression. Pharmacol Rep 2021; 73:1020-1032. [PMID: 34003475 PMCID: PMC8413152 DOI: 10.1007/s43440-021-00274-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 01/23/2023]
Abstract
Depression is a highly prevalent mood disorder and one of the major health concerns in modern society. Moreover, it is characterized by a high prevalence of coexistence with many other diseases including metabolic disorders such as type 2 diabetes mellitus (T2DM) and obesity. Currently used antidepressant drugs, which mostly target brain monoaminergic neurotransmission, have limited clinical efficacy. Although the etiology of depression has not been fully elucidated, current scientific data emphasize the role of neurotrophic factors deficiencies, disturbed homeostasis between the nervous system and the immune and endocrine systems, as well as disturbances in brain energy metabolism and dysfunctions in the gut-brain axis as important factors in the pathogenesis of this neuropsychiatric disorder. Therefore, therapeutic options that could work in a way other than classic antidepressants are being sought to increase the effectiveness of the treatment. Interestingly, glucagon-like peptide-1 receptor agonists (GLP-1RAs), used in the treatment of T2DM and obesity, are known to show pro-cognitive and neuroprotective properties, and exert modulatory effects on immune, endocrine and metabolic processes in the central nervous system. This review article discusses the potential antidepressant effects of GLP-1RAs, especially in the context of their action on the processes related to neuroprotection, inflammation, stress response, energy metabolism, gut-brain crosstalk and the stability of the gut microbiota.
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Affiliation(s)
- Jan Detka
- Laboratory of Immunoendocrinology, Department of Experimental Neuroendocrinology, Polish Academy of Sciences, Maj Institute of Pharmacology, 12 Smętna Street, 31-343, Cracow, Poland.
| | - Katarzyna Głombik
- Laboratory of Immunoendocrinology, Department of Experimental Neuroendocrinology, Polish Academy of Sciences, Maj Institute of Pharmacology, 12 Smętna Street, 31-343, Cracow, Poland
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6
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Neuroendocrine tumor (NET) of the vagina in the light of WHO 2020 2-tiered grading system: clinicopathological report of the first described case. Virchows Arch 2021; 480:687-691. [PMID: 33881615 DOI: 10.1007/s00428-021-03078-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
Up to now, a vaginal well-differentiated neuroendocrine tumor (NET) has never been well described in the literature. A 2-cm vaginal nodule morphologically revealed a proliferation of mild to moderately atypical eosinophilic epithelioid cells, without tumor cell necrosis. Immunohistochemistry (IHC) showed positivity for CK (AE1/AE3), chromogranin A, and synaptophysin, focal positivity for CDX2, and negativity for PAX8 and TTF1. Metastatic origin was excluded by imaging and the morphological context with benign mucinous glands as present in the surgical resection specimen. Considering mitotic index and Mib1/Ki67 (8 mitoses/2 mm2; >20%), the case was diagnosed as vaginal NET G2 in the light of the WHO 2020 grading system for the gynecologic neuroendocrine neoplasms (NENs). Ranges of Mib1-Ki67 are not yet standardized. Currently, mitotic index and tumor cell necrosis were taken into consideration for the grading system. Gynecologic NENs still represent a diagnostic challenge. A clinico-radiologic workup and an appropriate diagnostic path ruling out the metastatic nature are mandatory to achieve the diagnosis.
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7
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Kusunoki S, Fujino K, Hirayama T, Ota T, Terao Y, Itakura A, Takeda S. Primary Vaginal Small-Cell Carcinoma Treated with Concurrent Chemoradiotherapy and Interstitial Irradiation: A Case Report and Review of the Literature. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Soshi Kusunoki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazunari Fujino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takaskhi Hirayama
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tsuyoshi Ota
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yasuhisa Terao
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Primary intestinal-type glandular lesions of the vagina: clinical, pathologic, and immunohistochemical features of 14 cases ranging from benign polyp to adenoma to adenocarcinoma. Am J Surg Pathol 2014; 38:593-603. [PMID: 24722061 DOI: 10.1097/pas.0000000000000157] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary intestinal-type glandular lesions of the vagina are rare. We report a series of 14 lesions, including 1 intestinal-type polyp without neoplastic features, 3 adenomas (2 with high-grade dysplasia), and 10 adenocarcinomas. Patients ranged in age from 20 to 86 years (mean 60 y) and presented with vaginal bleeding or a mass. No history of diethylstilbestrol exposure, adenosis, or endometriosis was elicited in any patient. The lesions were mostly polypoid, small (0.8 to 2.0 cm), and located in the posterior (6 cases) and lower (7 cases) vagina. One carcinoma metastasized to a para-aortic lymph node; the others were confined to the vagina. The neoplasms exhibited histologic features identical to those seen in primary large intestinal tumors, including variable numbers of goblet cells and in 1 case neuroendocrine cells. Five of the adenocarcinomas contained areas consistent with a precursor adenoma. In 3 cases, a benign urothelium-lined duct was adjacent to the lesion, and in 2 patients benign intestinal-type epithelium was present; no other potential benign precursor lesions were seen. Immunohistochemical analysis was performed on 6 cases; the tumors were positive for CDX-2 (6/6), CK20 (5/6), CEA (5/5), CK7 (4/6), and CA-125 (2/4) and were negative for ER (0/6) and p16 (0/2). Clinical outcome data were available in 3 patients with adenocarcinomas; 1 died of disease in <1 year, and 2 were alive with no evidence of disease at 2 and 7 years. The pertinent literature is reviewed, and the potential origin and differential diagnosis of these lesions are discussed.
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Sánchez-Arca M, Pérez Valcarcel J, Casal A, Íñiguez F. Tumor carcinoide de vagina. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2008. [DOI: 10.1016/s0210-573x(08)73037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Ditto A, Martinelli F, Carcangiu ML, Hanozet F, Solima E, Barisella M, Cerrotta A, Raspagliesi F. Incidental Diagnosis of Primary Vaginal Adenocarcinoma of Intestinal Type. Int J Gynecol Pathol 2007; 26:490-3. [PMID: 17885503 DOI: 10.1097/pgp.0b013e318047ffe5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary vaginal adenocarcinoma of intestinal type is a rare malignant gynecologic disease. A 53-year-old woman was admitted to our institution with a diagnosis of endometrial adenocarcinoma. A physical examination revealed a 2-cm polypoid lesion of the vagina. The patient underwent surgery for endometrial cancer and wedge resection of the vaginal lesion. The diagnosis of primary vaginal adenocarcinoma of intestinal type was obtained after standard and immunohistochemical analyses of the specimen. No endometrial cancer was detected in the specimen. Radiological investigations excluded metastasis from the gastrointestinal tract. Subsequently, the patient underwent concomitant chemoradiation. At present, 32 months later, she is well and disease-free. Extensive radiological investigations and careful immunohistochemical analysis of the specimen are needed for a correct diagnosis of vaginal adenocarcinoma of intestinal type. Concomitant chemoradiation, as a primary treatment, should be considered.
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Affiliation(s)
- Antonino Ditto
- Department of Gynecologic Oncology, Istituto Nazionale Tumori, Milan, Italy.
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11
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Tjalma WAA, Colpaert CGA. Primary vaginal adenocarcinoma of intestinal type arising from a tubulovillous adenoma. Int J Gynecol Cancer 2007; 16:1461-5. [PMID: 16803550 DOI: 10.1111/j.1525-1438.2006.00575.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Enteric or intestinal-type neoplasms of the vagina are extremely rare. The present report describes a 55-year-old woman who presented with a 6-week history of postmenopausal bleeding. On clinical examination, a lesion on the posterior vaginal wall was noticed. Rectovaginal examination suggested a tumor in the rectovaginal septum. Biopsy revealed an adenocarcinoma of the intestinal type, with a small remnant of a villous adenoma. The histologic interpretation pointed in the direction of a metastatic gastrointestinal tumor; yet, clinical examination, rectoscopy, colonoscopy, magnetic resonance imaging (MRI) of the abdomen, and positron emission tomography (PET) scanning excluded this possibility. This led to the conclusion that the lesion was a primary intestinal-type adenocarcinoma of the vagina that had arisen from a vaginal villous adenoma. It is important to be aware of this tumor type and to distinguish them from metastatic colorectal adenocarcinoma in order to plan appropriate treatment.
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Affiliation(s)
- W A A Tjalma
- Departments of Gynecology and Gynecologic Oncology and Pathology, University Hospital Antwerpen (UZA), Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium.
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12
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Abstract
Mixed endocrine tumors are tumors composed of at least two distinct tumor populations, one of which is endocrine. Because of their rarity and unusual presentation, endocrine mixed tumors raise many problems of diagnosis, management and therapy. Three main types of endocrine mixed tumors are recognized: The existence of these various types has been confirmed by recent molecular studies, even if the same studies have also shown that the histogenesis of a mixed endocrine tumor cannot be predicted from its histological features. Composite tumors are the less rare mixed tumors. The recent WHO classification recommends to restrict the term of composite endocrine tumor to the epithelial tumors containing at least 30% of obviously tumoral endocrine cells; some authors recommend to use higher thresholds, of at least 50%, in order to avoid overdiagnosis. The endocrine component is usually well differentiated, easily identified by its suggestive histological features; the endocrine nature of tumor cells is confirmed by the immunodetection of specific endocrine and neuro-endocrine markers (such as chromogranin A and synaptophysin). In some cases, the endocrine component is poorly differentiated: the demonstration of neuro-endocrine markers is necessary to confirm the diagnosis. Mixed tumors can occur in every anatomical site; they are more frequent in organs containing endocrine cells in the normal state (especially the digestive tract and the pancreas), but they can also be observed in organs devoid of endocrine cells (such as the mammary gland). The management of mixed endocrine tumors must take into account the more aggressive component. Mixed tumors containing a well differentiated endocrine component and an adenocarcinomatous component are to be treated like adenocarcinomas. Mixed tumors containing a poorly differentiated endocrine component must be considered as poorly differentiated endocrine carcinomas.
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Affiliation(s)
- Valérie Hervieu
- Service Central d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, 3 place d'Arsonval, 69437 Lyon cedex
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13
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Bing Z, Levine L, Lucci JA, Hatch SS, Eltorky MA. Primary Small Cell Neuroendocrine Carcinoma of the Vagina: A Clinicopathologic Study. Arch Pathol Lab Med 2004; 128:857-62. [PMID: 15270619 DOI: 10.5858/2004-128-857-pscnco] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Primary small cell neuroendocrine carcinoma of the vagina is extremely rare, and its clinical behavior is aggressive. To our knowledge, 22 patients with this tumor have been reported in the English literature to date.
Objective.—To investigate 3 patients with this tumor clinically and pathologically.
Design.—The pathology database at the University of Texas Medical Branch at Galveston was searched, and 3 cases of primary small cell neuroendocrine carcinoma of the vagina were found. The histologic, immunohistochemical, and ultrastructural profiles of the tumors were investigated. The medical charts of the patients were reviewed, and the patients were followed up.
Patients.—Women with the diagnosis of primary small cell neuroendocrine carcinoma of vagina.
Results.—All 3 patients presented with advanced disease, and 2 patients died within 4 months of the initial diagnosis. One 38-year-old patient was newly diagnosed, and her clinical outcome had not yet been determined. The histologic features of all 3 tumors were similar to those of their pulmonary counterpart. All cases were positive for cytokeratin, chromogranin A, and synaptophysin. The expression pattern of thyroid transcription factor 1 was examined in all 3 patients, of whom 2 were negative and 1 was positive with negative clinical and radiologic thyroid or pulmonary findings. Ultrastructural evaluation showed scattered intracytoplasmic electron-dense neurosecretory granules.
Conclusion.—Primary small cell neuroendocrine carcinoma of the vagina has histologic, immunohistochemical, and ultrastructural features similar to those of its pulmonary counterpart. Because thyroid transcription factor 1 can be positive, it should not be used to differentiate primary from metastatic disease. The current therapies have usually resulted in poor outcomes, and new therapeutic modalities should be explored.
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Affiliation(s)
- Zhanyong Bing
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555-0588, USA
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14
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Kaminski JM, Anderson PR, Han AC, Mitra RK, Rosenblum NG, Edelson MI. Primary small cell carcinoma of the vagina. Gynecol Oncol 2003; 88:451-5. [PMID: 12648603 DOI: 10.1016/s0090-8258(02)00153-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary vaginal small cell carcinoma is extremely rare, with a total number reported in English-language journals to date of 23. Most patients die of the disease within 2 years of diagnosis from metastatic disease. CASE A 69-year-old woman presented with vaginal spotting while on Premarin. She was subsequently diagnosed with Stage I (T1N0M0) small cell carcinoma of the vagina. She underwent concurrent chemoradiation and then brachytherapy for persistent disease. Due to residual disease after the brachytherapy, surgical resection was planned but aborted because of metastatic disease. CONCLUSIONS Of the three reported cases treated with concurrent chemoradiation, ours is the first case reported with persistent local disease after therapy. Extrapolating from the available clinical trials from lung carcinoma, concurrent chemoradiation as a primary treatment approach should still be considered.
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Affiliation(s)
- Joseph M Kaminski
- Department of Radiation Oncology, Fox Chase Cancer Center, 7701 Burholme Ave., Philadelphia, PA 19111, USA
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15
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Ciesla MC, Guidos BJ, Selvaggi SM. Cytomorphology of small-cell (neuroendocrine) carcinoma on ThinPrep cytology as compared to conventional smears. Diagn Cytopathol 2001; 24:46-52. [PMID: 11135469 DOI: 10.1002/1097-0339(200101)24:1<46::aid-dc1008>3.0.co;2-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Small-cell (neuroendocrine) carcinoma of the female genital tract is an uncommon, aggressive neoplasm that occurs most commonly in the cervix and rarely in the vagina. Although the cytologic findings have been reported on conventional smears, the cytologic diagnosis of primary vaginal small-cell carcinoma on ThinPrep material has not been previously reported. We present a case of a 46-yr-old woman who underwent cervical/vaginal biopsies as a result of abnormal cells seen on the ThinPrep Pap Test. Small to medium-sized cells with scant cytoplasm were present singly and in loose, cohesive clusters. Nuclear molding was noted in a few cellular groups. The differential diagnosis included a high-grade squamous intraepithelial lesion, small-cell (neuroendocrine) carcinoma, endometrial adenocarcinoma, and lymphoma. Subsequent tissue biopsies with immunohistochemical staining confirmed a diagnosis of small-cell carcinoma of the vagina. The cytologic features of small-cell (neuroendocrine) carcinoma on slides prepared by the ThinPrep Pap Test are discussed and compared to those on conventional cervicovaginal smears.
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Affiliation(s)
- M C Ciesla
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
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16
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Heller DS, Merrell M, Sama J, Anderson J, Cracchiolo B. Periurethral vaginal adenocarcinoma of the intestinal type: report of two cases and review of the literature. Gynecol Oncol 2000; 77:478-81. [PMID: 10831365 DOI: 10.1006/gyno.2000.5791] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Vaginal adenocarcinomas in the absence of diethylstilbestrol (DES) exposure are rare neoplasms. Only a few cases with enteric type histology have been reported. Also rare are urethral adenocarcinomas in women. CASE REPORTS Two cases of vaginal adenocarcinoma of the intestinal type in the absence of DES exposure are presented. Both cases arose in the periurethral area, raising the issue of urethral as well as vaginal origin. DISCUSSION The possible histogenesis of these neoplasms is considered.
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Affiliation(s)
- D S Heller
- Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey, Newark New Jersey, 07103, USA.
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17
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Mirhashemi R, Kratz A, Weir MM, Molpus KL, Goodman AK. Vaginal small cell carcinoma mimicking a Bartholin's gland abscess: a case report. Gynecol Oncol 1998; 68:297-300. [PMID: 9570984 DOI: 10.1006/gyno.1998.4959] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of a 32-year-old woman with a lesion in the vagina which clinically mimicked a Bartholin's gland abscess, but was demonstrated to be a small cell carcinoma by light microscopy. This tumor is very rare and to our knowledge there are 13 reported cases of primary vaginal small cell carcinoma in the English literature. The mean age of presentation of this neoplasm in the 13 reported cases is 61 with a median survival of 12 months. This case stresses the importance of considering this unusual diagnosis when confronted with a large or recurrent "Bartholin's gland lesion," and underlines the need for careful pathological examination of such specimens.
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Affiliation(s)
- R Mirhashemi
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston 02114, USA
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18
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Abstract
We report a case of vaginal small cell (neuroendocrine) carcinoma. Immunostaining for neuron-specific enolase, PGP 9.5, chromogranin, synaptophysin, Leu 7 and cytokeratin was positive. Neurosecretory granules were found by electronmicroscopy. There was local recurrence and regional lymph node metastases. The patient survived for 10 months following local surgical therapy only.
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Affiliation(s)
- J R Miliauskas
- Division of Tissue Pathology, Gribbles Pathology, Institute of Medical & Veterinary Science, Adelaide, Australia
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19
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Abstract
A 65-year-old woman with a history of recurrent vaginal intraepithelial neoplasia was found to have small cell carcinoma (SCC). Exfoliative cytology was instrumental in the discovery of each episode of vaginal neoplasia. Thorough examination of the patient established the tumor as being primary to the vagina, and immunohistochemistry confirmed it to be a neuroendocrine SCC. Eleven patients with neuroendocrine SCC of the vagina have been reported previously. Morphologic characteristics and histogenesis are discussed within the context of the embryology and natural history of extrapulmonary-genital SCC. They have been classified in the amine precursor uptake and decarboxylation family of neoplasms. Originally, a neuroectodermal origin was proposed, but derivation now is thought to be from multipotential epithelial stem cells of the genital tract. Neuroendocrine SCC tends to be an aggressive neoplasm with a propensity for early spread. Long-term survival for patients with vaginal SCC has not been documented. Therapeutic decisions regarding SCC from this site have been based on information gained from the treatment of these tumors elsewhere. Combined modality therapy using initial surgery and adjuvant treatment, including systemic chemotherapy and local exposure to radiation, has produced an apparent complete response in our patient.
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Affiliation(s)
- R E Joseph
- Department of Obstetrics and Gynecology, Darnall Army Community Hospital, Fort Hood, Texas
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20
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Husain AN, Gattuso P, Abraham K, Castelli MJ. Synchronous adenocarcinoma and carcinoid of the uterine cervix: immunohistochemical study of a case and review of literature. Gynecol Oncol 1989; 33:125-8. [PMID: 2649419 DOI: 10.1016/0090-8258(89)90617-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Mixed neoplasms, adenocarcinoma and carcinoid, have been reported to occur in several areas of the body, including gastrointestinal tract, breast, prostate, lung, skin, and kidney. Mixed tumors of the uterine cervix are very rare. Their histogenesis, immunohistochemical profile, and prognosis are not well established. Here, we report a case of a 49-year-old female with infiltrating adenocarcinoma of the cervix within which was found a separate nodule of small cell endocrine carcinoma.
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Affiliation(s)
- A N Husain
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois 60153
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