1
|
Lyu YH, Liu HX, Han X, Yuan P, Wang MY, He YY, Ge JL, Zou W, Jing R, Xin CS, Yang H, Chen BL, Chen GW, Li J. Clinicopathologic characteristics and prognostic factors of patients with surgically treated high-grade neuroendocrine carcinoma of the cervix: A multicenter retrospective study. Int J Gynaecol Obstet 2024. [PMID: 39031110 DOI: 10.1002/ijgo.15771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE To evaluate the prognostic factors and survival outcomes of patients with surgically treated high-grade neuroendocrine carcinoma of the cervix (NECC). METHODS This multicenter, retrospective study involved 98 cervical cancer patients with stage IA2-IIA2 and IIIC1/2p high-grade NECC. We divided the patients into two groups based on histology: the pure and mixed groups. All clinicopathologic variables were retrospectively evaluated. Cox regression and Kaplan-Meier methods were used for analysis. RESULTS In our study, 60 patients were in the pure group and 38 patients were in the mixed group. Cox multivariate analysis showed that mixed histology was a protective factor impacting overall survival (OS) (P = 0.026) and progression free survival (PFS) (P = 0.018) in surgically treated high-grade NECC. Conversely, survival outcomes were negatively impacted by ovarian preservation (OS: HR, 20.84; 95% CI: 5.02-86.57, P < 0.001), age >45 years (OS: HR, 4.50; 95% CI: 1.0-18.83, P = 0.039), tumor size >4 cm (OS: HR, 6.23; 95% CI: 2.34-16.61, P < 0.001), parity >3 (OS: HR, 4.50; 95% CI: 1.02-19.91, P = 0.048), and perineural invasion (OS: HR, 5.21; 95% CI: 1.20-22.53, P = 0.027). Kaplan-Meier survival curves revealed notable differences in histologic type (OS: P = 0.045; PFS: P = 0.024), chemotherapy (OS: P = 0.0056; PFS: P = 0.0041), ovarian preservation (OS: P = 0.00031; PFS: P = 0.0023), uterine invasion (OS: P < 0.0001; PFS: P < 0.0001), and depth of stromal invasion (OS: P = 0.043; PFS: P = 0.022). CONCLUSION Patients with mixed histologic types who undergo surgery for high-grade NECC have a better prognosis. Meanwhile, ovarian preservation, tumor size >4 cm, parity >3, age >45 years and perineural invasion were poor prognostic predictors. Therefore, patients with high-risk factors should be considered in clinical practice.
Collapse
Affiliation(s)
- Yan-Hong Lyu
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Hai-Xia Liu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Obstetrics and Gynecology, Liao Cheng People's Hospital, Liaocheng, Shandong, China
| | - Xue Han
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Peng Yuan
- Department of Gynecology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - Ming-Yi Wang
- Department of Gynecology and Obstetrics, General Hospital of Western Theater Command of PLA, Chengdu, Sichuan Province, China
| | - Yuan-Yuan He
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Jun-Li Ge
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Wei Zou
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Ru Jing
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Cai-Shi Xin
- Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Hong Yang
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Bi-Liang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Gao-Wen Chen
- Obstetrics and Gynecology Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jia Li
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| |
Collapse
|
2
|
Bayani L, Shahbazkhani AH, Seifollahy A, Kashany L, Torabi S. Diagnostic challenges in primary ovarian carcinoid: Insights from radiological imaging-A case study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:809-812. [PMID: 38597286 DOI: 10.1002/jcu.23687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/30/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
Primary ovarian carcinoid (POC) is a very rare subset of ovarian tumors, presenting diagnostic challenges due to its inconclusive radiological imaging. In this case study, we present a 30-year-old nulliparous female with subfertility complaints and irregular menstrual cycles, who was initially misdiagnosed with an ovarian cyst. Subsequent comprehensive imaging, including Color Doppler, revealed high vascularity, and prompting suspicion of malignancy. Surgical resection and histopathological evaluation ultimately confirmed the presence of a rare Carcinoid tumor, insular type. This case emphasizes a multidisciplinary approach to the early detection and accurate diagnosis of POCs.
Collapse
Affiliation(s)
- Leila Bayani
- Department of Radiology, Arash Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Akram Seifollahy
- Department of Pathology, Arash Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Kashany
- Department of Infertility, Arash Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarah Torabi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Ferreira Dalla Pria HR, Sharbidre KG, Virarkar M, Javadi S, Bhosale H, Maxwell J, Lall C, Morani AC. Imaging Update for Hereditary Abdominopelvic Neuroendocrine Neoplasms. J Comput Assist Tomogr 2024; 48:533-544. [PMID: 37832535 DOI: 10.1097/rct.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
ABSTRACT Neuroendocrine neoplasms have shown a linear increase in incidence and prevalence in recent decades, primarily due to improved cross-sectional imaging, expanded use of endoscopic procedures, and advanced genetic analysis. However, diagnosis of hereditary neuroendocrine tumors is still challenging because of heterogeneity in their presentation, the variety of tumor locations, and multiple associated syndromes. Radiologists should be familiar with the spectrum of these tumors and associated hereditary syndromes. Furthermore, as the assessment of multiple tumor elements such as morphology, biochemical markers, and presence of metastatic disease are essential for the treatment plan, conventional anatomic and functional imaging methods are fundamental in managing and surveilling these cases. Our article illustrates the role of different cross-sectional imaging modalities in diagnosing and managing various hereditary abdominopelvic neuroendocrine tumors.
Collapse
Affiliation(s)
| | - Kedar G Sharbidre
- Abdominal Imaging Section, Department of Radiology, University of Alabama at Birmingham, AL
| | - Mayur Virarkar
- Department of Radiology, University of Florida College of Medicine-Jacksonville, FL
| | - Sanaz Javadi
- Department of Abdominal Imaging, Division of Diagnostic Imaging
| | | | - Jessica Maxwell
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine-Jacksonville, FL
| | | |
Collapse
|
4
|
Huynh CG, Truong BHT, Thai TT, Doan PTT. Small-Cell Neuroendocrine Cervical Carcinoma Mimicking a Polyp in a 20-Year-Old Patient With a Five-Year Follow-Up: A Case Report. Cureus 2024; 16:e62893. [PMID: 39040766 PMCID: PMC11261534 DOI: 10.7759/cureus.62893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
Small-cell neuroendocrine cervical carcinoma (NECC) is a rare histology, and diagnosis and treatment of this condition are challenging because of its rarity, non-specific abdominopelvic symptoms, and less favorable prognosis compared to other cervical cancers. Here, we present a case of a 20-year-old patient diagnosed with small-cell NECC, defined within a cervical polyp, initially mimicking a benign lesion. Because of the difficulty in diagnosis, the patient underwent thorough diagnostics and interventions, including imaging, histopathology, and immunohistochemistry. Initially, the patient underwent a distinctive treatment plan encompassing four cycles of cisplatin and etoposide chemotherapy with minimal side effects. Subsequently, she received comprehensive surgical interventions, including hysterectomy, lymphadenectomy, and bilateral salpingectomy. Ovarian preservation, justified by the patient's youth and small cervical lesions (<4 cm) without parametrial disease or metastatic signs, was pursued. For long-term outcomes, the patient demonstrated no metastasis or recurrence during a five-year follow-up. This case emphasizes the requirement for strengthened awareness of neuroendocrine tumors in cervical masses, particularly in young patients, and the importance of individualized treatment approaches for optimal clinical outcomes. Continued documentation of such cases increases our understanding of managing infrequent cervical malignancies.
Collapse
Affiliation(s)
- Chau Giang Huynh
- Department of Pathology, Hung Vuong Hospital, Ho Chi Minh City, VNM
| | - Bich-Ha Thi Truong
- Department of Obstetrics and Gynecology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, VNM
| | - Truc Thanh Thai
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Phuong-Thao Thi Doan
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| |
Collapse
|
5
|
Saraei P, Heshmati A, Hosseini S. Small-cell neuroendocrine carcinoma of the female genital tract: A comprehensive overview. J Neuroendocrinol 2024; 36:e13394. [PMID: 38626758 DOI: 10.1111/jne.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/15/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
Small-cell neuroendocrine carcinomas (SCNECs) of the female genital tract are rare and aggressive tumors that are characterized by a high rate of recurrence and poor prognosis. They can arise from various sites within the female genital tract, including the cervix, endometrium, ovary, fallopian tube, vagina, and vulva. They are composed of cells with neuroendocrine features, such as the ability to produce and secrete hormones and peptides, and a high mitotic rate. Immunohistochemical staining for neuroendocrine markers, such as chromogranin A, synaptophysin, and CD56, can aid in the diagnosis of these tumors. This article provides an overview of the epidemiology, etiology, and risk factors associated with these tumors, as well as their clinical presentation, cellular characteristics, diagnosis, and finally the current treatment options for SCNECs, including surgery, chemotherapy, and radiation therapy, alone or in combination.
Collapse
MESH Headings
- Humans
- Female
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/therapy
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Small Cell/therapy
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/epidemiology
- Carcinoma, Small Cell/pathology
- Genital Neoplasms, Female/therapy
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/epidemiology
- Risk Factors
Collapse
Affiliation(s)
- Pouya Saraei
- Department of Medical Physics, Medicine School, Ahvaz Jondishapur University of Medical Sciences, Ahvaz, Iran
| | - Abbas Heshmati
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sare Hosseini
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
6
|
Chalif J, Kistenfeger Q, Fulton J, Morton M, DeVengencie I, Weldemichael W, Vazzano J, O'Malley DM, Chambers LM. Diagnosis and management of gastric-type endocervical adenocarcinoma: A case report and review of the literature. Gynecol Oncol 2024; 185:165-172. [PMID: 38428332 DOI: 10.1016/j.ygyno.2024.02.024] [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] [Received: 01/02/2024] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Abstract
Gastric-type endocervical adenocarcinoma (GEA), a rare subtype of cervical cancer, has garnered increasing attention recently for its distinctive histopathological features, unique classification, genetic characteristics, and variable clinical outcomes compared to squamous cell and adenocarcinoma subtypes. Historically, GEA has evolved from a poorly understood entity to a distinct subtype of cervical adenocarcinoma, only recently recognized in the 2020 World Health Organization (WHO) classification. Accordingly, characteristic morphological features define GEA, shedding light on the diagnostic challenges and potential misclassification that can occur in clinical practice. Genetic alterations, including KRAS, ARID1A, and PIK3CA mutations, play a pivotal role in the development and progression of GEA. This article reviews a case of GEA and aims to provide a contemporary overview of the genetic mutations and molecular pathways implicated in GEA pathogenesis, highlighting potential therapeutic targets and the prospects of precision medicine in its management. Patients with GEA have variable clinical outcomes, with some exhibiting aggressive behavior while others follow a more indolent course. This review examines the factors contributing to this heterogeneity, including stage at diagnosis, histological grade, and genetic alterations, and their implications for patient prognoses. Treatment strategies for GEA remain a topic of debate and research. Here, we summarize the current therapeutic options, including surgery, radiation therapy, and chemotherapy, while also exploring emerging approaches, such as targeted therapies and immunotherapy. This article provides a comprehensive overview of GEA, synthesizing current knowledge from historical perspectives to contemporary insights, focusing on its classification, genetics, outcomes, and therapeutic strategies.
Collapse
Affiliation(s)
- Julia Chalif
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
| | - Quinn Kistenfeger
- Division of Obstetrics & Gynecology, The Ohio State University, Columbus, OH, USA
| | - Jessica Fulton
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Molly Morton
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | | | - Wegahta Weldemichael
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer Vazzano
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David M O'Malley
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Laura M Chambers
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| |
Collapse
|
7
|
Liu X, Tian Y, Yan S, Fu H, Si L, Lai T, Mao M, Wang Q, Bai J, Li H, Guo R. Neuroendocrine carcinoma of the endometrium: a retrospective analysis of data from a single center. BMC Cancer 2024; 24:636. [PMID: 38789995 PMCID: PMC11127372 DOI: 10.1186/s12885-024-12393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Neuroendocrine carcinoma (NEC) originating from the endometrium is rare, and there is limited knowledge regarding its diagnosis and optimal management. In this study, we present our experience with 11 patients with endometrial NEC, aiming to provide guidance for clinical practice. METHODS We retrospectively collected the clinical, pathological, and treatment data of 11 patients with endometrial NEC who were treated at the First Affiliated Hospital of Zhengzhou University from January 2011 to July 2023. The clinicopathological characteristics, treatment and prognosis of these patients were analyzed. RESULTS The median age of the patients was 55.0 (39.0-64.0) years, and the median tumor size was 40.0 (33.0-60.0) mm. Irregular vaginal bleeding was the most common symptom observed in 10 out of 11 patients, while metabolic syndrome occurred in only 2 out of 11 patients. Six out of the 11 patients were diagnosed at an early stage. Among the patients, 6 were diagnosed with endometrial NECs, while the remaining patients had a combination of endometrial NEC and other non-NEC endometrial carcinomas. All patients underwent surgery, except for one who received only chemotherapy due to multiple metastases. After surgery, adjuvant chemotherapy was administered to 5 patients, chemotherapy combined with radiotherapy was given to 3 patients, and 2 patients did not receive any adjuvant therapy. A total of 10 patients completed the follow-up, with a median follow-up time of 51.0 (14.3-81.0) months. Unfortunately, 2 patients died from the disease. CONCLUSION NECs originating from the endometrium might not be affected by metabolic disorders. Preoperative diagnosis of these tumors was challenging. The primary approach for managing endometrial NEC can be multimodal treatment centered around surgery.
Collapse
Affiliation(s)
- Xueyan Liu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, PR China
| | - Yanpeng Tian
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, PR China
| | - Shuping Yan
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Hanlin Fu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, PR China
| | - Lulu Si
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, PR China
| | - Tianjiao Lai
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, PR China
| | - Meng Mao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, PR China
| | - Qian Wang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, PR China
| | - Jing Bai
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, PR China
| | - Heli Li
- Department of Ultrasonography, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Ruixia Guo
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, PR China.
| |
Collapse
|
8
|
Zeng F, Guo P, Xia M, He M. Total hysterectomy versus radical hysterectomy in neuroendocrine cervical cancer: a SEER-database analysis. J Cancer Res Clin Oncol 2024; 150:236. [PMID: 38710946 PMCID: PMC11074048 DOI: 10.1007/s00432-024-05773-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE We conducted this study to evaluate the efficacy of total hysterectomy versus radical hysterectomy in the treatment of neuroendocrine cervical cancer (NECC). METHODS Eligible NECC patients were identified from the Surveillance, Epidemiology and End Results (SEER) database. Demographic characteristics, clinical treatment and survival of the patients were collected. The overall survival (OS) and cancer-specific survival (CSS) were estimated by Kaplan-Meier analysis with log-rank test. RESULTS A total of 286 patients were included, with 104 patients undergoing total hysterectomy and 182 patients undergoing radical hysterectomy. The 5-year OS were 50.8% in the total hysterectomy group and 47.5% in the radical hysterectomy group (p = 0.450); and the corresponding 5-year CSS were 51.6% and 49.1% (p = 0.494), respectively. Along with surgery, radiotherapy was given to 49.0% of patients in the total hysterectomy group and 50.5% in the radical hysterectomy group; and chemotherapy was administered to 77.9% of patients in the total hysterectomy group and 85.7% in the radical hysterectomy group. Unexpectedly, in patients who received adjuvant radiotherapy with or without chemotherapy, the OS was superior in the total hysterectomy group compared with the radical hysterectomy group (p = 0.034). While in patients who received chemotherapy alone and those who received neither radiotherapy nor chemotherapy, the OS still remained comparable between the total hysterectomy and radical hysterectomy group. CONCLUSION Compared with radical hysterectomy, total hysterectomy was not associated with compromised survival prognosis in patients with NECC. Total hysterectomy has the potential to be a surgical alternative in the multimodal management of NECC.
Collapse
Affiliation(s)
- Feitianzhi Zeng
- Department of Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peng Guo
- Department of Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Meng Xia
- Department of Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Mian He
- Department of Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
| |
Collapse
|
9
|
Flores Legarreta A, Saab R, Gonzales NR, Chisholm GB, Westin SN, Hillman RT, Frumovitz M. Neuroendocrine neoplasms of the ovary: a review of 63 cases. Int J Gynecol Cancer 2024; 34:566-573. [PMID: 38290783 DOI: 10.1136/ijgc-2023-005063] [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: 02/01/2024] Open
Abstract
OBJECTIVE To describe the clinicopathological characteristics and survival outcomes of ovarian neuroendocrine neoplasms from a curated registry. METHODS This is a retrospective cross-sectional study of patients in our registry with confirmed ovarian neuroendocrine neoplasms. We excluded patients with small cell carcinoma not otherwise specified, small cell hypercalcemic type, and those with neuroendocrine 'features' or 'differentiation.' Clinicopathological characteristics were described in two separate groups: patients with carcinoid tumors and patients with neuroendocrine carcinomas. Progression-free and overall survival were estimated with the Kaplan-Meier product-limit estimator in these two groups, and multivariable analysis was done to identify predictors of survival for neuroendocrine carcinomas only. RESULTS A total of 63 patients met inclusion criteria, 13 (21%) with carcinoid tumors and 50 (79%) with neuroendocrine carcinomas. In the carcinoid tumor group, one patient (8%) was misdiagnosed. Two patients (15%) had a recurrence and the 5-year overall survival rate was 80% (95% CI 45% to 100%), with a lower bound of the median survival of 4.8 years (95% CI). In the neuroendocrine carcinoma group, 23 patients (46%) were misdiagnosed, 16 of whom (69%) received therapy with the presumption of a non-neuroendocrine carcinoma diagnosis. Thirty patients (60%) had a recurrence, and the 5-year overall survival rate was 24% (10%, 38%), with a median survival of 1.6 years (1.3, 3.3). Patients with carcinomas stage III or IV had an increased risk of progression/recurrence (HR=5.6; 95% CI 1.9 to 17.0) and death (HR=8.1; 95% CI 2.2 to 29.7) compared with those with stage I or II. Pure histology was associated with an increased risk of progression/recurrence (HR=2.3; 95% CI 1.0 to 5.2) compared with admixed histology. CONCLUSION Most patients had neuroendocrine carcinomas, which were associated with a higher recurrence rate and worse survival than carcinoid tumors. A high proportion of patients in both groups were initially misdiagnosed, and a new association with endometrial hyperplasia was observed. Neuroendocrine admixed histology is associated with a higher risk of progression.
Collapse
Affiliation(s)
- Alejandra Flores Legarreta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Reem Saab
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naomi R Gonzales
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gary B Chisholm
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - R Tyler Hillman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
10
|
Le Guévelou J, Selleret L, Laas E, Lecuru F, Kissel M. Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies. Cancers (Basel) 2024; 16:1341. [PMID: 38611019 PMCID: PMC11011172 DOI: 10.3390/cancers16071341] [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: 02/19/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer during pregnancy is defined as a tumor diagnosed in a pregnant woman or up to 1-year post-partum. While being a rare disease, cervical cancer is probably one of the most challenging medical conditions, with the dual stake of treating the cancer without compromising its chances for cure, while preserving the pregnancy and the health of the fetus and child. To date, guidelines for gynecological cancers are provided through international consensus meetings with expert panels, giving insights on both diagnosis, treatment, and obstetrical care. However, these expert guidelines do not discuss the various approaches than can be found within the literature, such as alternative staging modalities or innovative surgical approaches. Also, the obstetrical care of women diagnosed with cervical cancer during pregnancy requires specific considerations that are not provided within our current standard of care. This systematic review aims to fill the gap on current issues with regards to the management of cervical cancer during pregnancy and provide future directions within this evolving landscape.
Collapse
Affiliation(s)
- Jennifer Le Guévelou
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Radiation Oncology, Centre Eugène Marquis, 35000 Rennes, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75005 Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, 75005 Paris, France
| | - Enora Laas
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
- Université de Paris, 75006 Paris, France
| | - Manon Kissel
- Department of Radiation Oncology, Institut Curie, 75005 Paris, France
| |
Collapse
|
11
|
Molla YD, Alemu HT, Selamawi AE, Tesema AY, Answar IO, Tadesse AK. Adenocarcinoma admixed with neuroendocrine carcinoma of the cervix: A case report and review of literature. Case Rep Womens Health 2024; 41:e00594. [PMID: 38515997 PMCID: PMC10955200 DOI: 10.1016/j.crwh.2024.e00594] [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] [Received: 02/23/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
A 40-year-old Ethiopian woman presented with a six-month history of non-foul-smelling whitish vaginal discharge. She also reported a one-year history of postcoital bleeding. A pelvic examination revealed a nodular, hard, and fragile cervical mass. In addition, there were nontender, firm nodules in the epigastric, periumbilical, gluteal areas, and thyroid gland. Investigations, including abdominopelvic ultrasound, magnetic resonance imaging, fine-needle aspiration cytology, and immunohistochemistry, confirmed mixed neuroendocrine carcinoma of the cervix with metastasis to the abdominal wall, gluteal area, lumbar vertebrae, and thyroid gland. The patient was started on palliative chemotherapy. Metastatic adenocarcinoma admixed with neuroendocrine carcinoma of the cervix presents a formidable disease phenotype, characterized by complex diagnostic and therapeutic obstacles. Multidisciplinary cooperation among oncologists, radiologists, pathologists, and surgeons is required to refine treatment approaches and improve patient prognoses for this uncommon and intricate malignancy.
Collapse
Affiliation(s)
- Yohannis Derbew Molla
- Department of Surgery, College of Medicine and Health Sciences, University of Gondar, 196 Gondar, Ethiopia
| | - Hirut Tesfahun Alemu
- College of Medicine and Health Sciences, University of Gondar, 196 Gondar, Ethiopia
| | - Almaz Enku Selamawi
- Department of Radiology, College of Medicine and Health Sciences, University of Gondar, 196 Gondar, Ethiopia
| | - Amare Yeshitla Tesema
- Department of Oncology, College of Medicine and Health Sciences, University of Gondar, 196 Gondar, Ethiopia
| | - Isak Omer Answar
- Department of Pathology, College of Medicine and Health Sciences, University of Gondar, 196 Gondar, Ethiopia
| | - Amanuel Kassa Tadesse
- Department of Pathology, College of Medicine and Health Sciences, University of Gondar, 196 Gondar, Ethiopia
| |
Collapse
|
12
|
Masuda M, Iida K, Iwabuchi S, Tanaka M, Kubota S, Uematsu H, Onuma K, Kukita Y, Kato K, Kamiura S, Nakajima A, Coppo R, Kanda M, Yoshino K, Ueda Y, Morii E, Kimura T, Kondo J, Okada-Hatakeyama M, Hashimoto S, Inoue M. Clonal Origin and Lineage Ambiguity in Mixed Neuroendocrine Carcinoma of the Uterine Cervix. THE AMERICAN JOURNAL OF PATHOLOGY 2024; 194:415-429. [PMID: 38103888 DOI: 10.1016/j.ajpath.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/23/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
Small-cell neuroendocrine carcinoma (SCNEC) of the cervix is a rare disease characterized by a high incidence of mixed tumors with other types of cancer. The mechanism underlying this mixed phenotype is not well understood. This study established a panel of organoid lines from patients with SCNEC of the cervix and ultimately focused on one line, which retained a mixed tumor phenotype, both in vitro and in vivo. Histologically, both organoids and xenograft tumors showed distinct differentiation into either SCNEC or adenocarcinoma in some regions and ambiguous differentiation in others. Tracking single cells indicated the existence of cells with bipotential differentiation toward SCNEC and adenocarcinomas. Single-cell transcriptional analysis identified three distinct clusters: SCNEC-like, adenocarcinoma-like, and a cluster lacking specific differentiation markers. The expression of neuroendocrine markers was enriched in the SCNEC-like cluster but not exclusively. Human papillomavirus 18 E6 was enriched in the SCNEC-like cluster, which showed higher proliferation and lower levels of the p53 pathway. After treatment with anticancer drugs, the expression of adenocarcinoma markers increased, whereas that of SCNEC decreased. Using a reporter system for keratin 19 expression, changes in the differentiation of each cell were shown to be associated with the shift in differentiation induced by drug treatment. These data suggest that mixed SCNEC/cervical tumors have a clonal origin and are characterized by an ambiguous and flexible differentiation state.
Collapse
Affiliation(s)
- Masamune Masuda
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keita Iida
- Laboratory of Cell Systems, Institute for Protein Research, Osaka University, Osaka, Japan
| | - Sadahiro Iwabuchi
- Department of Molecular Pathophysiology, Institute of Advanced Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mie Tanaka
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoshi Kubota
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan; Department of Biochemistry, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyuki Uematsu
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kunishige Onuma
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoji Kukita
- Department of Molecular and Medical Genetics, Osaka International Cancer Institute, Osaka, Japan
| | - Kikuya Kato
- Department of Molecular and Medical Genetics, Osaka International Cancer Institute, Osaka, Japan
| | - Shoji Kamiura
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Aya Nakajima
- Department of Biochemistry, Osaka International Cancer Institute, Osaka, Japan; Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Roberto Coppo
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mizuki Kanda
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jumpei Kondo
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Biochemistry, Osaka International Cancer Institute, Osaka, Japan
| | | | - Shinichi Hashimoto
- Department of Molecular Pathophysiology, Institute of Advanced Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Inoue
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Biochemistry, Osaka International Cancer Institute, Osaka, Japan.
| |
Collapse
|
13
|
Lamiman K, Wilhelm AB, Eyzaguirre E, Richardson G. Diagnostic Challenges and Long-term Outcomes of Neuroendocrine Carcinoma of the Cervix: A Case Series. Int J Gynecol Pathol 2024; 43:149-157. [PMID: 37922936 PMCID: PMC10852037 DOI: 10.1097/pgp.0000000000000983] [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: 11/07/2023]
Abstract
Neuroendocrine carcinomas (NECs) of the cervix are rare, aggressive malignancies that are challenging to diagnose and treat. They are high-grade lesions that often share features with poorly differentiated adenocarcinoma and squamous cell carcinoma. NECs are classified into large-cell or small-cell subtypes but can often have a mixed appearance or occur concurrently with a squamous or adenocarcinoma. Diagnosis is dependent on tissue sampling, histomorphology, and immunohistochemistry. Eight cases of NEC were retrieved from the Department of Pathology at our institution from 2008 to 2022. Tumor slides were reviewed and evaluated by 2 independent pathologists. Seven of 8 patients tested positive for neuroendocrine markers, including CD56, synaptophysin, and chromogranin. We discuss the diagnostic challenges, review the histopathology, and describe the treatment courses and clinical outcomes. This case series reveals that traditional markers, such as p16, p63, and p40, may be focally positive in NEC and should not be considered a confirmation of squamous cell carcinoma. Patient outcomes can be affected by delays in diagnosis, misdiagnosis, and inadequate treatment when NEC is not considered in the initial differential diagnosis.
Collapse
|
14
|
Savelli Binsted A, Kassem Z, Le D, de Veciana M. Small Cell Cervical Carcinoma in Pregnancy: Therapeutic Options for an Aggressive Cancer Diagnosis. AJP Rep 2024; 14:e22-e25. [PMID: 38269128 PMCID: PMC10805566 DOI: 10.1055/s-0043-1777998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 10/22/2023] [Indexed: 01/26/2024] Open
Abstract
Neuroendocrine small cell cervical carcinoma is an aggressive cancer which accounts for approximately 1 to 3% of all cervical neoplasms. Therapy must be altered in pregnancy to optimize maternal-fetal outcomes. A 39-year-old woman presented for a routine prenatal visit and was noted to have a grossly abnormal cervix. Cervical biopsies confirmed small cell carcinoma. At 19 weeks' gestation, chemotherapy was initiated. The patient delivered at 34 weeks' gestation to initiate radiation therapy. Six months later, she was diagnosed with metastatic disease and died from cancer complications. In pregnancy, treatment modalities for small cell cervical carcinoma are based on the patient's gestational age at diagnosis. While aggressive early treatment is preferred, platinum-based chemotherapy can be initiated in the second trimester and radiation therapy delayed until delivery. Small cell cervical carcinoma complicating pregnancy requires aggressive treatment. Chemotherapy in the second trimester with planned delayed radiation therapy, may optimize fetal outcomes.
Collapse
Affiliation(s)
- Alyssa Savelli Binsted
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Zeinab Kassem
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - David Le
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Margarita de Veciana
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| |
Collapse
|
15
|
Barcellini A, Golia D'Augè T, Mandato VD, Cuccu I, Musella A, Fruscio R, Vitale MG, Martinello R, Mangili G, Pignata S, Palaia I. Primary neuroendocrine neoplasms of the vulva: A review of the MITO rare cancer group. Crit Rev Oncol Hematol 2024; 193:104201. [PMID: 37977312 DOI: 10.1016/j.critrevonc.2023.104201] [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] [Received: 04/26/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
Gynecological neuroendocrine neoplasms are rare entities and can be divided into two groups: carcinoids and neuroendocrine carcinomas. Due to their rarity their management is not standardized. The aim of this work is to summarize and discuss the current literature evidence on this pathology. A scoping literature review was performed in multiple databases. Thirty-one studies were included: 30 case reports and one case series. Patients' age ranged between 28 and 92 years. Surgery was the most used treatment and the surgical approach included local excision (N = 16/31; 51.6%) with (N = 5/16; 31.25%) or without (N = 11/16; 68.75%) inguinal lymphadenectomy. Adjuvant radiotherapy was delivered in 12 (38.7%) cases; instead, platinum-based therapies were frequently used when chemotherapy was chosen for adjuvant treatment. The overall survival ranged between 20 days to 4 years. However, further research is needed; currently, multimodal approach including surgery, chemotherapy and radiotherapy appeared safe and feasible for the treatment of these rare and aggressive diseases.
Collapse
Affiliation(s)
- Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Tullio Golia D'Augè
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy.
| | - Vincenzo Dario Mandato
- Unit of Obstetrics and Gynaecology, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Ilaria Cuccu
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Angela Musella
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Robert Fruscio
- University of Milan Bicocca, IRCCS San Gerardo, Monza, Italy
| | - Maria Giuseppa Vitale
- Department of Oncology and Hematology, University Hospital of Modena, 41100 Modena, Italy
| | - Ruby Martinello
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Italy
| | - Giorgia Mangili
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, IRCCS Milan, Italy
| | - Sandro Pignata
- Uro-Gynecological Medical Oncology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| |
Collapse
|
16
|
Fattorini C, Rocca BJ, Giusti A, Arganini M, Perotti B, Cavazzana A, Ambrosio MR, Volante M. Mixed mucinous adenocarcinoma/large cell neuroendocrine carcinoma of the uterine cervix: case report and molecular characterization of a rare entity. Virchows Arch 2024; 484:141-146. [PMID: 36988712 PMCID: PMC10052266 DOI: 10.1007/s00428-023-03532-7] [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] [Received: 12/07/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Mixed neuroendocrine-non-neuroendocrine carcinomas of the cervix are rare and generally aggressive diseases. They often present at an advanced stage with hematogenous or lymphatic metastases. The prognosis is poor, mostly influenced by the neuroendocrine component. Unfortunately, the rarity of the disease caused a lack of information about its pathogenesis and molecular landscape. The latest guidelines recommend a multimodal approach that usually includes radical surgery, platinum/etoposide-based chemotherapy, or chemoradiation. Here, we are presenting a case of metastatic mixed adenocarcinoma-large cell neuroendocrine carcinoma of the cervix in a 49-year-old female patient. The molecular characterization of the lesion highlighted the ubiquitous presence of human papillomavirus-18 DNA both in the adenocarcinomatous and the neuroendocrine components, suggesting a role for the virus in the pathogenesis. Moreover, a different set of mutations was detected in the two parts, thus ruling out a possible clonal evolution of the neuroendocrine component from the adenocarcinoma one. More studies are needed to clarify the molecular landscape of these rare lesions and identify putative targets for therapy.
Collapse
Affiliation(s)
- Caterina Fattorini
- Pathology Unit, Azienda Sanitaria Toscana Nord Ovest, Via Cocchi 1, 56121, Pisa, Italy
| | - Bruno J Rocca
- Pathology Unit, Azienda Sanitaria Toscana Nord Ovest, Via Cocchi 1, 56121, Pisa, Italy
| | - Andrea Giusti
- Pathology Unit, Azienda Sanitaria Toscana Nord Ovest, Via Cocchi 1, 56121, Pisa, Italy
| | - Marco Arganini
- Surgery Unit, Ospedale Unico Versilia, Azienda Sanitaria Toscana Nord Ovest, 56121, Pisa, Italy
| | - Bruno Perotti
- Surgery Unit, Ospedale Unico Versilia, Azienda Sanitaria Toscana Nord Ovest, 56121, Pisa, Italy
| | - Andrea Cavazzana
- Pathology Unit, Azienda Sanitaria Toscana Nord Ovest, Via Cocchi 1, 56121, Pisa, Italy
| | - Maria R Ambrosio
- Pathology Unit, Azienda Sanitaria Toscana Nord Ovest, Via Cocchi 1, 56121, Pisa, Italy.
| | - Marco Volante
- Pathology Unit, Department of Oncology at San Luigi Hospital, University of Turin, Orbassano, Italy
| |
Collapse
|
17
|
Stumpo S, Formelli MG, Persano I, Parlagreco E, Lauricella E, Rodriquenz MG, Guerrera LP, Zurlo IV, Campana D, Brizzi MP, Cives M, La Salvia A, Lamberti G. Extrapulmonary Neuroendocrine Carcinomas: Current Management and Future Perspectives. J Clin Med 2023; 12:7715. [PMID: 38137784 PMCID: PMC10743506 DOI: 10.3390/jcm12247715] [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: 11/04/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Neuroendocrine carcinomas (NECs) are poorly differentiated and highly aggressive epithelial neuroendocrine neoplasms. The most common primary site is the lung, but they may arise in every organ. Approximately 37% of extrapulmonary NECs (EP-NECs) occur in the gastroenteropancreatic (GEP) tract, followed by the genitourinary (GU) system and gynecological tract. As a result of their rarity, there is scant evidence to guide treatment recommendations, and a multidisciplinary approach is essential for the management of such patients. Platinum-based chemotherapy currently represents the standard of care for EP-NECs of any site, mirroring the management of small-cell lung cancer (SCLC), but further approaches are still under investigation. Indeed, ongoing trials evaluating targeted therapies, immune checkpoint inhibitors (ICIs), and radionuclide therapy could provide potentially breakthrough therapeutic options. Given the relative dearth of evidence-based literature on these orphan diseases, the aim of this review is to provide an overview of the pathology and current treatment options, as well as to shed light on the most pressing unmet needs in the field.
Collapse
Affiliation(s)
- Sara Stumpo
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
| | - Maria Giovanna Formelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
| | - Irene Persano
- Medical Oncology, AO S. Croce e Carle, 12100 Cuneo, Italy; (I.P.); (E.P.)
| | - Elena Parlagreco
- Medical Oncology, AO S. Croce e Carle, 12100 Cuneo, Italy; (I.P.); (E.P.)
| | - Eleonora Lauricella
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (E.L.); (M.C.)
| | - Maria Grazia Rodriquenz
- Oncology Unit, Ospedale IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Luigi Pio Guerrera
- Division of Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
- Sarcomas and Rare Tumors Unit, Istituto Nazionale Tumori, IRCCS-Fondazione “G. Pascale”, 80131 Naples, Italy
| | | | - Davide Campana
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Maria Pia Brizzi
- Department of Oncology, A.O.U. San Luigi Gonzaga Hospital, 10043 Orbassano, Italy;
| | - Mauro Cives
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (E.L.); (M.C.)
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), 00161 Rome, Italy
| | - Giuseppe Lamberti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
- Medical Oncology Unit, Vito Fazzi Hospital, 73100 Lecce, Italy;
| |
Collapse
|
18
|
Gurubalan G, Parwaiz A, Ajit S, Kumar T, Kumari M, Bhadani P. Small cell neuroendocrine carcinoma with adenocarcinoma and high grade squamous intraepithelial neoplasia of the cervix. Autops Case Rep 2023; 13:e2023452. [PMID: 38034519 PMCID: PMC10688200 DOI: 10.4322/acr.2023.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/17/2023] [Indexed: 12/02/2023]
Abstract
Neuroendocrine neoplasm (NEN) of the cervix is a malignant tumor and is classified into low and intermediate-grade neuroendocrine tumor (NET), and high-grade small cell neuroendocrine carcinoma (SCNEC), and large cells neuroendocrine carcinoma (LCNEC). SCNEC of the cervix is an Infrequent tumor with an incidence of less than 1% of all gynecological malignancies. It is characterized by small to medium-sized tumor cells with scant cytoplasm and neuroendocrine differentiation. Most cases of SCNEC of the cervix manifest in pure forms, and only cases show coexisting, non-neuroendocrine component of HPV-associated adenocarcinoma or squamous cell carcinoma. In this report, reviewing the literature, we present one such unique case of SCNEC of the cervix with adenocarcinoma and high-grade squamous intraepithelial neoplasia.
Collapse
Affiliation(s)
| | - Amber Parwaiz
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Surabhi Ajit
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Tarun Kumar
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Madhu Kumari
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Punam Bhadani
- All India Institute of Medical Sciences, Patna, Bihar, India
| |
Collapse
|
19
|
Ren X, Wu W, Li Q, Li W, Wang G. Advances in Research, Diagnosis, and Treatment of Neuroendocrine Cervical Carcinoma: A Review. Oncol Rev 2023; 17:11764. [PMID: 38025893 PMCID: PMC10645581 DOI: 10.3389/or.2023.11764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Neuroendocrine neoplasms (NENs) were classified separately in the 5th edition (2020) of the World Health Organization (WHO) classification of female genital malignancies. Cervical neuroendocrine carcinoma (NEC) is distinguished by its low incidence, high invasiveness, early local dissemination, and distant metastases. The purpose of this review is to outline the achievements in pathology, diagnostics, gene sequencing, and multi-modality treatment of cervical NEC.
Collapse
Affiliation(s)
| | - Wenjuan Wu
- Department of Gynecological Oncology, The Affiliated Women’s and Children’s Hospital of Chengdu Medical College, Chengdu, China
| | - Qiufan Li
- Chengdu Medical College, Chengdu, China
| | - Wen Li
- Chengdu Medical College, Chengdu, China
| | - Gang Wang
- Department of Gynecological Oncology, The Affiliated Women’s and Children’s Hospital of Chengdu Medical College, Chengdu, China
| |
Collapse
|
20
|
Suresh A, Ferriss JS. Incorporation of immunotherapy into the treatment of metastatic neuroendocrine carcinoma of the cervix: A case report. Gynecol Oncol Rep 2023; 49:101263. [PMID: 37663173 PMCID: PMC10474144 DOI: 10.1016/j.gore.2023.101263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023] Open
Abstract
•Ideal treatment for advanced neuroendocrine carcinoma of the cervix (NECC) remains unclear.•A patient with metastatic NECC experienced a durable complete response to multi-modal therapy that included atezolizumab.•Atezolizumab may improve response rates and overall survival when incorporated into therapy for NECC.
Collapse
Affiliation(s)
- Akanksha Suresh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Stuart Ferriss
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
21
|
Xiang X, Zhang Y, Hua K, Ding J. Impacts of ovarian preservation on the prognosis of neuroendocrine cervical carcinoma: a retrospective analysis based on machine learning. World J Surg Oncol 2023; 21:146. [PMID: 37173713 PMCID: PMC10176922 DOI: 10.1186/s12957-023-03014-9] [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: 01/24/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Neuroendocrine cervical carcinoma (NECC) is a rare but aggressive malignancy with younger patients compared to other common histology types. This study aimed to evaluate the impacts of ovarian preservation (OP) on the prognosis of NECC through machine learning. METHODS Between 2013 and 2021, 116 NECC patients with a median age of 46 years received OP or bilateral salpingo-oophorectomy (BSO) and were enrolled in a retrospective analysis with a median follow-up of 41 months. The prognosis was estimated using Kaplan-Meier analysis. Random forest, LASSO, stepwise, and optimum subset prognostic models were constructed in training cohort (randomly selected 70 patients) and tested in 46 patients through receiver operator curves. Risk factors for ovarian metastasis were identified through univariate and multivariate regression analyses. All data processing was carried out in R 4.2.0 software. RESULTS Among 116 patients, 30 (25.9%) received OP and showed no significantly different OS compared with BSO group (p = 0.072) and got better DFS (p = 0.038). After construction of machine learning models, the safety of OP was validated in lower prognostic risk group (p > 0.05). In patients ≤ 46 years, no impacts of OP were shown for DFS (p = 0.58) or OS (p = 0.67), and OP had no impact on DFS in different relapse risk population (p > 0.05). In BSO group, regression analyses showed that later stage, para-aortic LNM, and parametrial involvement were associated with ovarian metastasis (p < 0.05). CONCLUSIONS Preserving ovaries had no significant impact on prognosis in patients with NECC. OP should be considered cautiously in patients with ovarian metastasis risk factors.
Collapse
Affiliation(s)
- Xuesong Xiang
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shen-Yang Road, Shanghai, 200011, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
| | - Yunqiang Zhang
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shen-Yang Road, Shanghai, 200011, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
| | - Keqin Hua
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shen-Yang Road, Shanghai, 200011, People's Republic of China.
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China.
| | - Jingxin Ding
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shen-Yang Road, Shanghai, 200011, People's Republic of China.
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China.
| |
Collapse
|
22
|
Chen J, Ma N, Sun M, Chen L, Yao Q, Chen X, Lin C, Lu Y, Lin Y, Lin L, Fan X, Chen Y, Wu J, He H. Prognostic value of apparent diffusion coefficient in neuroendocrine carcinomas of the uterine cervix. PeerJ 2023; 11:e15084. [PMID: 37020850 PMCID: PMC10069420 DOI: 10.7717/peerj.15084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/25/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives
This research was designed to examine the associations between the apparent diffusion coefficient (ADC) values and clinicopathological parameters, and to explore the prognostic value of ADC values in predicting the International Federation of Gynecology and Obstetrics (FIGO) stage and outcome of patients suffering from neuroendocrine carcinomas of the uterine cervix (NECCs).
Methods
This retrospective study included 83 patients with NECCs, who had undergone pre-treatment magnetic resonance imaging (MRI) between November 2002 and June 2019. The median follow-up period was 50.7 months. Regions of interest (ROIs) were drawn manually by two radiologists. ADC values in the lesions were calculated using the Functool software. These values were compared between different clinicopathological parameters groups. The Kaplan–Meier approach was adopted to forecast survival rates. Prognostic factors were decided by the Cox regression method.
Results
In the cohort of 83 patients, nine, 42, 23, and nine patients were in stage I, II, III, and IV, respectively. ADCmean, ADCmax, and ADCmin were greatly lower in stage IIB–IVB than in stage I–IIA tumours, as well as in tumours measuring ≥ 4 cm than in those < 4 cm. ADCmean, FIGO stage, and age at dianosis were independent prognostic variables for the 5-year overall survival (OS). ADCmin, FIGO stage, age at diagnosis and para-aortic lymph node metastasis were independent prognostic variables for the 5-year progression-free survival (PFS) in multivariate analysis. For surgically treated patients (n = 45), ADCmax was an independent prognostic parameter for both 5-year OS and 5-year PFS.
Conclusions
ADCmean, ADCmin, and ADCmax are independent prognostic factors for NECCs. ADC analysis could be useful in predicting the survival outcomes in patients with NECCs.
Collapse
Affiliation(s)
- Jian Chen
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Ning Ma
- Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Mingyao Sun
- Department of Clinical Nutrition, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Li Chen
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Qimin Yao
- College of Finance, Fujian Jiangxia University, Fuzhou, Fujian, China
| | - XingFa Chen
- Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Cuibo Lin
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yongwei Lu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yingtao Lin
- Department of Drug Clinical Trial Institution, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Liang Lin
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Xuexiong Fan
- Department of Medical Record, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yiyu Chen
- Department of Pathology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Jingjing Wu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Haixin He
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| |
Collapse
|
23
|
Verma S, Dubey H, Gupta S, Ranjan A, Goel H, Sharma A. Neuroendocrine carcinoma of cervix and review literature. Int J Surg Case Rep 2023; 105:107982. [PMID: 36948055 PMCID: PMC10040689 DOI: 10.1016/j.ijscr.2023.107982] [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: 01/17/2023] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Neuroendocrine carcinoma of the cervix (NECC) is a rare variant of cervical cancer with poor prognosis and high mortality. Recurrence is seen with multi-organ metastasis including liver. CASE PRESENTATION A 65 year old female presented with vaginal bleeding for the past one year. Cervical cancer screening and biopsy demonstrated poorly differentiated squamous carcinoma. Immunohistochemistry showed positive expression of chromogranin, synaptophysin, pancytokeratin, TTP1, and CEA and negative expression of p40 and estrogen receptors. An adenocarcinoma with neuroendocrine tumor was suggested. Hysterectomy with bilateral salpingo-oophrectomy was performed. This was followed by carboplatin and etoposide therapy to have clinical remission for a year. Then recurrence was observed to start same drugs again resulting in to partial improvement. It was followed by radiotherapy. The patient succumbed to death approximately after three months. CONCLUSION A metastatic lesion in liver may be a case of Neuroendocrine tumor of cervix, a rare condition that can be easily missed on histopathological examination. More studies are required to establish a standard therapeutic protocol.
Collapse
Affiliation(s)
- Saransh Verma
- All India Institute of Medical Sciences, Delhi, India.
| | - Harshita Dubey
- Dr. B.R.A. Institute - Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
| | - Swati Gupta
- Dr. B.R.A. Institute - Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
| | - Amar Ranjan
- Dr. B.R.A. Institute - Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
| | - Harsh Goel
- Dr. B.R.A. Institute - Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
| | - Anil Sharma
- All India Institute of Medical Sciences, Delhi, India.
| |
Collapse
|
24
|
A Nomogram Model Based on Neuroendocrine Markers for Predicting the Prognosis of Neuroendocrine Carcinoma of Cervix. J Clin Med 2023; 12:jcm12031227. [PMID: 36769874 PMCID: PMC9917535 DOI: 10.3390/jcm12031227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Combining traditional clinical parameters with neuroendocrine markers to construct a nomogram model to predict the postoperative recurrence of neuroendocrine carcinoma of cervix (NECC). METHODS A total of 257 patients were included in this study. Univariate and multivariate Cox regression analyses were used to establish a nomogram model in the training cohorts, which was further validated in the validation cohorts. The calibration curve was used to conduct the internal and external verification of the model. RESULTS Overall, 41 relapse cases were observed in the training (23 cases) and validation (18 cases) cohorts. The univariate analysis preliminarily showed that FIGO stage, stromal invasion, nerve invasion, lymph vascular space invasion, lymph node involvement, cervical-uterine junction invasion and CgA were correlated with NECC recurrence. The multivariate analysis further confirmed that FIGO stage (p = 0.023), stromal invasion (p = 0.002), lymph vascular space invasion (p = 0.039) and lymph node involvement (p = 0.00) were independent risk factors for NECC recurrence, which were ultimately included in the nomogram model. In addition, superior consistency indices were demonstrated in the training (0.863, 95% CI 0.784-0.942) and validation (0.884, 95% CI 0.758-1.010) cohorts. CONCLUSIONS The established nomogram model combining traditional clinical parameters with neuroendocrine markers can reliably and accurately predict the recurrence risks in NECC patients.
Collapse
|
25
|
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.
Collapse
|
26
|
Muacevic A, Adler JR, Sahu P. A Rare Case of Small-Cell Neuroendocrine Cancer of the Cervix: An Unexpected Diagnosis. Cureus 2023; 15:e34006. [PMID: 36811044 PMCID: PMC9939080 DOI: 10.7759/cureus.34006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
Cervical cancer is a significant healthcare problem worldwide, especially in developing countries. It is the second most common cause of cancer-related deaths in women. Small-cell neuroendocrine cancer of the cervix (SCNCC) accounts for about 1-3% of all cervical cancers. In this report, we present a case of a patient with SCNCC, whose disease had metastasized to the lungs even without an obvious growth in the cervix. A 54-year-old multiparous woman presented with post-menopausal bleeding for 10 days; she had a history of a similar episode in the past. Examination revealed an erythematous posterior cervix and upper vagina without any obvious growth. Histopathology showed SCNCC on the biopsy specimen. Following further investigations, the stage assigned was IVB, and she was started on chemotherapy. SCNCC is an extremely rare but highly aggressive type of cervical cancer and it requires a multidisciplinary therapeutic approach for an optimal standard of care.
Collapse
|
27
|
Kalampokas E, Giannis G, Alexandrou P, Kritikos E, Triantafyllidou O, Kalampokas T, Vlahos N, Marinis S. Small-cell neuroendocrine carcinoma of the vagina: A case report. Int J Gynaecol Obstet 2022; 161:678-679. [PMID: 36453163 DOI: 10.1002/ijgo.14603] [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: 08/12/2022] [Revised: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To present a rare case of small-cell neuroendocrine carcinoma of the vagina. METHOD A 79-year-old Caucasian woman presented to the hospital of Leros, a distant Greek island, with a 6-month history of "vaginal pressure feeling" and bleeding. Gynecologic examination revealed a 4- to 5-cm lesion on the lower third of the anterior vaginal wall. The patient declined a transfer to a tertiary hospital in Athens, so no biopsy could be obtained before surgery. RESULTS The tumor was resected surgically. Histology indicated a small-cell carcinoma of the vagina. CONCLUSION There is no consensus on the treatment of small-cell neuroendocrine carcinoma of the vagina. The rarity of the condition should motivate the founding of data-collection registries, in order to obtain a better understanding of the condition and optimize management and treatment.
Collapse
Affiliation(s)
- Emmanouil Kalampokas
- Unit of Gynecologic Oncology, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Giannis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Alexandrou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Olga Triantafyllidou
- Unit of Obstetrics and Gynecology, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Kalampokas
- Unit of Obstetrics and Gynecology, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vlahos
- Unit of Obstetrics and Gynecology, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Marinis
- Unit of Obstetrics and Gynecology, Leros Hospital, Leros, Greece
| |
Collapse
|
28
|
Li YZ, Liu P, Mao BH, Wang LL, Ren JL, Xu YS, Liu GY, Xin ZH, Lei JQ. Development of an improved diagnostic nomogram for preoperative prediction of small cell neuroendocrine cancer of the cervix. Br J Radiol 2022; 95:20220368. [PMID: 36169239 PMCID: PMC9733602 DOI: 10.1259/bjr.20220368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/09/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Accurate preoperative diagnosis of small cell neuroendocrine cancer of the cervix (SCNECC) is crucial for establishing the best treatment plan. This study aimed to develop an improved, non-invasive method for the preoperative diagnosis of SCNECC by integrating clinical, MR morphological, and apparent diffusion coefficient (ADC) information. METHODS A total of 105 pathologically confirmed cervical cancer patients (35 SCNECC, 70 non-SCNECC) from multiple centres with complete clinical and MR records were included. Whole lesion histogram analysis of the ADC was performed. Multivariate logistic regression analysis was used to develop diagnostic models based on clinical, morphological, and histogram data. The predictive performance in terms of discrimination, calibration, and clinical usefulness of the different models was assessed. A nomogram for preoperatively discriminating SCNECC was developed from the combined model. RESULTS In preoperative SCNECC diagnosis, the combined model, which had a diagnostic AUC (area under the curve) of 0.937 (95% CI: 0.887-0.987), outperformed the clinical-morphological model, which had an AUC of 0.869 (CI: 0.788-0.949), and the histogram model, which had an AUC of 0.872 (CI: 0.792-0.951). The calibration curve and decision curve analyses suggest that the combined model achieved good fitting and clinical utility. CONCLUSIONS Non-invasive preoperative diagnosis of SCNECC can be achieved with high accuracy by integrating clinical, MR morphological, and ADC histogram features. The nomogram derived from the combined model can provide an easy-to-use clinical preoperative diagnostic tool for SCNECC. ADVANCES IN KNOWLEDGE It is clear that the therapeutic strategies for SCNECC are different from those for other pathological types of cervical cancer according to V 1.2021 of the NCCN clinical practice guidelines in oncology for cervical cancer. This research developed an improved, non-invasive method for the preoperative diagnosis of SCNECC by integrating clinical, MR morphological, and apparent diffusion coefficient (ADC) information.
Collapse
Affiliation(s)
| | - Peng Liu
- Department of Radiology, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, China
| | - Bao-Hong Mao
- Department of Clinical Medical Research Centre, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Li-Li Wang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | | | | | - Guang-Yao Liu
- Department of Magnetic Resonance, the Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | | | | |
Collapse
|
29
|
Zhu YX, Gao XP, Xin L, Jia YC. A case report of small cell ovarian neuroendocrine carcinoma combined with immunochemotherapy. Medicine (Baltimore) 2022; 101:e31445. [PMID: 36401483 PMCID: PMC9678510 DOI: 10.1097/md.0000000000031445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Small cell ovarian neuroendocrine (NE) carcinoma is a rare NE tumor with a low incidence, poor prognosis, and no standardized treatment. To date, there have been no clear reports on the efficacy or prognosis of combined immunological and chemotherapy-based approaches in patients with this type of tumor. METHODS We administered the immune checkpoint inhibitor tirelizumab (PD-1 mab), in combination with etoposide and cisplatin chemotherapy (EP), to a patient with small cell ovarian NE carcinoma to examine its efficacy and safety. RESULTS The evaluation of efficacy was PR for every 2 courses of application, and immunomaintenance therapy was administered after 6 courses of treatment. CONCLUSION Our studies indicate that tirelizumab combined with EP, may be an effective treatment for small cell ovarian NE carcinoma.
Collapse
Affiliation(s)
- Yuan-Xue Zhu
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Hebei, P.R. China
- Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding, Hebei, P.R. China
| | - Xiang-Peng Gao
- Department of Medical Oncology, Affiliated Hospital of Hebei University, College of Clinical Medicine, Hebei University, Baoding, Hebei, P.R. China
| | - Lei Xin
- Key Laboratory of Precise Diagnosis and Treatment of Glioma, College of Clinical Medicine, Hebei University, Hebei Province, Hebei, P.R. China
| | - You-Chao Jia
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Hebei, P.R. China
- Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding, Hebei, P.R. China
- *Correspondence: Youchao Jia, Department of Medical Oncology, Affiliated Hospital of Hebei University; Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, 212 Yuhua East Road, Baoding, Hebei 071000, P.R. China (e-mail: )
| |
Collapse
|
30
|
Pang L, Chen J, Chang X. Large-cell neuroendocrine carcinoma of the gynecologic tract: Prevalence, survival outcomes, and associated factors. Front Oncol 2022; 12:970985. [PMID: 36457506 PMCID: PMC9707296 DOI: 10.3389/fonc.2022.970985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/27/2022] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND We aimed to assess the clinical behavior of gynecologic large-cell neuroendocrine carcinoma (LCNEC) via a retrospective analysis of data from 469 patients. METHODS Patients diagnosed with gynecologic LCNEC from 1988 to 2015 were identified using the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox hazard regression analyses were performed to assess independent predictors of overall survival (OS) and cancer-specific survival (CSS). OS and CSS were also evaluated using the Kaplan-Meier method, and the effects of different treatment regimens on prognosis were compared according to disease stage. RESULTS Cervical, ovarian, and endometrial LCNEC were observed in 169, 219, and 79 patients, respectively. The 5-year OS rates for patients with cervical, ovarian, and endometrial LCNEC were 35.98%, 17.84%, and 23.21%, respectively, and the median duration of overall survival was 26, 11, and 11 months in each group. The 5-year CSS rates for the three groups were 45.23%, 19.23%, and 31.39%, respectively, and the median duration of CSS was 41, 12, and 11 months in each group. Multivariate analysis revealed that American Joint Committee on Cancer stage, lymph node metastasis, and chemotherapy were independent prognostic factors for OS and CSS in patients with cervical LCNEC. Lymph node metastasis, surgery, and chemotherapy were independent prognostic factors for OS and CSS in the ovarian group and for OS in the endometrial group. Lymph node metastasis and surgery were also independent prognostic factors for CSS in the endometrial group. CONCLUSION Surgery alone may help to improve overall survival and CSS in patients with early-stage cervical LCNEC. In contrast, surgery+chemotherapy and surgery+radiotherapy may help to improve survival in those with early-stage ovarian and endometrial LCNEC, respectively. Regardless of subtype, comprehensive treatment involving surgery, CTX, and RT should be considered to improve prognosis in patients with advanced-stage gynecologic LCNEC.
Collapse
Affiliation(s)
- Li Pang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jie Chen
- Centre of Journals, China Medical University, Shenyang, Liaoning, China
| | - Xiaohan Chang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
31
|
Marchocki Z, Swift B, Covens A. Small Cell and Other Rare Histologic Types of Cervical Cancer. Curr Oncol Rep 2022; 24:1531-1539. [PMID: 35947285 DOI: 10.1007/s11912-022-01316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper was to summarize the recent evidence on rare subtypes of cervical cancer including small-cell carcinoma of the cervix (SCCC), gastric-type adenocarcinoma, and carcinosarcoma. RECENT FINDINGS All three cervical cancer subtypes are aggressive with poor treatment response and high recurrence rates. Molecular studies have identified various actionable mutations in both SCCC (PIK3CA, MYC, TP53, PTEN, ARID1A, KRAS, BRCA2) and gastric-type adenocarcinoma (KRAS, ARID1A, PTEN). While there are a limited number of case reports demonstrating a favorable response for recurrent SCCC to immune checkpoint inhibitors, a larger case series failed to show benefit. The checkpoint inhibitors role in gastric-type adenocarcinoma and carcinosarcoma is yet to be determined. Ninety-one percent of SCCC cases show PARP expression, suggesting a possible role for PARP inhibitors; however, this has yet to be examined in future clinical trials. More studies are needed, with a focus on targeted therapies. The role of PARP inhibitors in SCCC is potentially promising, but significant collaboration between centers/groups will be required to achieve this.
Collapse
Affiliation(s)
- Zibi Marchocki
- Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada
| | - Brenna Swift
- Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada
| | - Allan Covens
- Division of Gynecologic Oncology, Sunnybrook, Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada.
| |
Collapse
|
32
|
Seino M, Nagase S, Ohta T, Yamagami W, Ebina Y, Kobayashi Y, Tabata T, Kaneuchi M, Enomoto T, Mikami M. Impact of adjuvant chemotherapy on the overall survival of patients with resectable bulky small cell neuroendocrine cervical cancer: a JSGO-JSOG joint study. J Gynecol Oncol 2022; 34:e4. [PMID: 36245224 PMCID: PMC9807360 DOI: 10.3802/jgo.2023.34.e4] [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] [Received: 03/12/2022] [Revised: 07/19/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to review the clinicopathological characteristics of small cell neuroendocrine cervical cancer (SCNEC) and to identify the optimal treatment. METHODS The Japanese Society of Gynecologic Oncology conducted a retrospective cohort study of SCNECs enrolled in the Gynecological Tumor Registry of the Japan Society of Obstetrics and Gynecology between 2004 and 2015. All cases were modified and unified by International Federation of Gynecology and Obstetrics 2008 (Union for International Cancer Control 7th edition). RESULTS There were 822 registered patients diagnosed with SCNEC from 2004 to 2015 which comprised 1.1% (822/73,698) of all uterine cervical cancer cases. Rates of lymph-node and distant metastasis were significantly higher in T1b2 (38.9% and 13.7%, respectively) than T1b1 (14.2% and 4.4%, respectively) (p<0.01). In IB2 and T1bN1M0 SCNEC, the 5-year survival rate with surgery followed by chemotherapy was significantly higher than that with surgery followed by radiation therapy/concurrent chemoradiation therapy (p<0.01). CONCLUSION SNCEC tumors >4 cm in size had greater rates of lymph-node and distant metastasis when compared with tumors ≤4 cm. Adjuvant chemotherapy, rather than radiotherapy, may improve prognosis after surgery in T1bN1M0 SCNEC.
Collapse
Affiliation(s)
- Manabu Seino
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan.
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tsuyoshi Ohta
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuhiko Ebina
- Division of Comprehensive Development Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yoichi Kobayashi
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masanori Kaneuchi
- Department of Obstetrics and Gynecology, Otaru General Hospital, Otaru, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical, Niigata, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| |
Collapse
|
33
|
Lu J, Li Y, Wang J. Small Cell (Neuroendocrine) Carcinoma of the Cervix: An Analysis for 19 Cases and Literature Review. Front Cell Infect Microbiol 2022; 12:916506. [PMID: 35909972 PMCID: PMC9326003 DOI: 10.3389/fcimb.2022.916506] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Cervical SCNEC is a rare and highly malignant invasive tumor. The incidence is low, at less than 5% of all cervical cancers. Moreover, most patients with small cell carcinoma are interrelated with high risk HPV (more familiar HPV 18). Compared to squamous cell carcinoma or adenocarcinoma, patients of cevical SCNEC are more prone to lymph node invasion early, so the clinical manifestation is usually local or distant metastasis. We summarized the clinical features of 19 patients with cervical small cell carcinoma in the Second Affiliated Hospital of Dalian Medical University from 2012 to 2021, and retrospectively analyzed data from 1576 patients in 20 related studies and more than 50 pieces of literature in recent years by searching PubMed, Google schalor, Cochrane Library, Clinicalkey, and other databases. The collected patient data included age, clinical manifestation, TCT, HPV detection, the size and morphology of the tumor, local invasion depth, stage, lymph node status, initial treatment method, tumor-free survival, and so on. The positive rates of CGA, SYN, and CD56 in our cases were high, and NSE was a moderately sensitive index. P16 and Ki67 were the most sensitive, and all patients were positive. We found that multimodal treatment can indeed improve tumor-free survival (DFS), but the prognosis of patients is still very poor. For the early stages, our treatment principles refer to the guidelines of SGO, international gynecological cancer Cooperation (GCIG), and NCCN. We suggest a combination of surgery, radiotherapy, and chemotherapy. However, the general state of advanced patients is poor, whether they can tolerate the operation after neoadjuvant chemotherapy, whether the operation area can remain tumor-free, and whether this treatment will prolong the survival time of patients still need to be further discussed. In order to better prolong the tumor-free survival and prognosis of patients, we need to find gene changes suitable for targeted therapy, so as to complete the clinical application of these treatment methods. Further works are needed to explore more effective therapy for cervical SCNEC.
Collapse
|
34
|
Qiu J, Xu J, Yao G, Zhu F, Wang Y, Fu Y. An Ovarian Large-Cell Neuroendocrine Carcinoma Accompanied by Clear Cell Carcinoma with Specific High Level of AFP: Case Report and Review of the Literature. Cancer Manag Res 2022; 14:2235-2241. [PMID: 35909650 PMCID: PMC9326035 DOI: 10.2147/cmar.s366771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
Large cell neuroendocrine carcinoma (LCNEC) is a rare histological subtype of ovarian cancer. A few cases have been reported in the literature with extreme invasiveness and a poor prognosis. However, there still have not been accepted criteria for diagnosis and treatment of LCNEC. Here we report an unmarried 37 year-old woman who was diagnosed with LCNEC associated with clear cell carcinoma and the tumor index was manifested with a specific increase of AFP. The case received six courses of etoposide and carboplatin chemotherapy as an adjuvant therapy after primary curative surgery. However, she relapsed within 6 months after surgery and metastasized rapidly to distant organs despite combined chemotherapy of paclitaxel, cisplatin, and bevacizumab, and died 18 months after primary surgery. This is the first reported case of LCNEC manifested with a specific increase of AFP and characteristically metastasized to the spine as recurrence. Reviewing our case as well as previously reported cases, LCNEC present with aggressive malignancy and vulnerable to distant metastasis through a hematogenous approach, we conjectured that adding Bevacizumab in primary chemotherapy may be beneficial to extend disease-free survival. But so far there is no recommendation of this regimen for treatment of LCNEC in current guidelines. Further research is needed to confirm this view so as to find the best treatment of LCNEC and improve the prognosis of these patients.
Collapse
Affiliation(s)
- Jian Qiu
- Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Jiewei Xu
- Department of General Surgery, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Guorong Yao
- Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Fengjia Zhu
- Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Yanyan Wang
- Department of Pathology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Yunfeng Fu
- Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, People’s Republic of China
- Correspondence: Yunfeng Fu, Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Xueshi Road #2, Hangzhou, 310006, People’s Republic of China, Tel +86-571-87061501, Fax +86-571-87061878, Email
| |
Collapse
|
35
|
Saha S, Ghosh P, Mukherjee G, Roy A. Metastatic Primary Neuroendocrine Tumor of Ovary—A Rare Presentation. Indian J Radiol Imaging 2022; 32:270-274. [PMID: 35924124 PMCID: PMC9340168 DOI: 10.1055/s-0042-1744233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Neuroendocrine tumors (NETs) occur more commonly in lungs, gastrointestinal tract, or pancreas. NETs in locations such as ovaries are rare, and they have been described mainly in case reports. Here we describe a patient with primary NET of ovary presenting with distant metastases to peritoneum, liver, lung, and mediastinal lymph nodes.
Collapse
Affiliation(s)
- Sanghamitra Saha
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Priya Ghosh
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Arunava Roy
- Department of Gynaeoncology, Tata Medical Center, Kolkata, West Bengal, India
| |
Collapse
|
36
|
Talia KL, Ganesan R. Neuroendocrine Neoplasia of the Female Genital Tract. Surg Pathol Clin 2022; 15:407-420. [PMID: 35715168 DOI: 10.1016/j.path.2022.02.012] [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: 06/15/2023]
Abstract
Neuroendocrine neoplasia is relatively uncommon in the female genital tract (FGT) and occurs at any site, most often the ovary and cervix. A unified dichotomous nomenclature, introduced by the World Health Organization Classification of Tumors in all fifth edition volumes, divides neuroendocrine neoplasms (NENs) into well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). The term carcinoid tumor is retained in the ovary and represents the commonest FGT NEN. NEC is most common in the cervix and is usually admixed with another human papillomavirus-associated epithelial neoplasm. Despite shared neuroendocrine differentiation, NET and NEC show diverse etiology, morphology, and clinical behavior.
Collapse
Affiliation(s)
- Karen L Talia
- Department of Pathology, Royal Women's Hospital and Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia.
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham, United Kingdom
| |
Collapse
|
37
|
Pang L, Guo Z. Differences in Characteristics and Outcomes Between Large-Cell Neuroendocrine Carcinoma of the Ovary and High-Grade Serous Ovarian Cancer: A Retrospective Observational Cohort Study. Front Oncol 2022; 12:891699. [PMID: 35600342 PMCID: PMC9114724 DOI: 10.3389/fonc.2022.891699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Owing to its extremely low incidence and the paucity of relevant reports, there is currently no recognized first-line treatment strategy for ovarian large-cell neuroendocrine carcinoma, and there are no statistics related to prognosis derived from large samples. This study aimed to investigate the characteristics, outcomes, and independent predictors of survival for ovarian large-cell neuroendocrine carcinoma and compare them with those of high-grade serous ovarian cancer. Methods The Surveillance, Epidemiology, and End Results database was used to identify women diagnosed with ovarian large-cell neuroendocrine carcinoma or high-grade serous ovarian cancer from 1988 to 2015. Clinical, demographic, and treatment characteristics were compared between the groups. Propensity-score matching, Cox risk regression analysis, and Kaplan-Meier survival curves were used to analyze the data. Results In total, 23,917 women, including 23,698 (99.1%) diagnosed with high-grade serous ovarian cancer and 219 (0.9%) diagnosed with ovarian large-cell neuroendocrine carcinoma, were identified. Age >77 years, diagnosis before 2003-2010, and advanced-stage disease were more common in patients with ovarian large-cell neuroendocrine carcinoma than in those with high-grade serous ovarian cancer. Women with ovarian large-cell neuroendocrine carcinoma were less likely to receive adjuvant chemotherapy (54.8% vs. 81.9%) but more likely to receive radiotherapy (3.2% vs. 1.5%; both P<0.001) than women with high-grade serous ovarian cancer. Stage, chemotherapy, and tumor size were independent predictors of overall survival, and the risk of death was greater in the advanced stage than in the early stage (P=0.047). Chemotherapy and tumor size were also independent predictors of cancer-specific survival. Overall and cancer-specific survival rates were significantly low for ovarian large-cell neuroendocrine carcinoma than for more malignant high-grade serous ovarian cancer. Conclusions Compared to patients with high-grade serous ovarian cancer, those with ovarian large-cell neuroendocrine carcinoma presented more often with advanced-stage disease and had decreased overall and cancer-specific survival rates.
Collapse
Affiliation(s)
- Li Pang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhiqiang Guo
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
38
|
Mai YF, Chan IS, Lai CR, Chen YJ. Primary poorly differentiated carcinoma of the vagina with focal neuroendocrine differentiation: a tumour with aggressive behaviour. BMJ Case Rep 2022; 15:e247554. [PMID: 35396236 PMCID: PMC8995952 DOI: 10.1136/bcr-2021-247554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 11/03/2022] Open
Abstract
Primary vaginal neuroendocrine tumours are extremely rare but aggressive. We report a case of primary poorly differentiated vaginal carcinoma with focal neuroendocrine differentiation. The clinical stage was cT3N1M0, FIGO stage III. The patient received six cycles of cisplatin-based concurrent chemoradiation therapy (CCRT) followed by six cycles of adjuvant chemotherapy (IEP protocol: ifosfomide, epirubicin and cisplatin). Pelvic MRI scans obtained after treatment completion revealed no residual tumour in the vagina. However, the patient experienced severe dyspnoea 2 months later. Chest X-ray revealed a reticulonodular interstitial pattern over bilateral lungs with suspicion of lymphangitic carcinomatosis. Further chest, abdominal and pelvic CT scans showed bilateral lung metastases with multiple mediastinal, left lower neck and left axilla, intra-abdominal and pelvic lymphadenopathies. For this rare tumour, cisplatin-based CCRT followed by IEP protocol adjuvant chemotherapy may have a limited treatment effect. Further studies are necessary to provide more information on clinical management.
Collapse
Affiliation(s)
- Yi-Fan Mai
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-San Chan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Obstetrics and Gynaecology, Division of Gynaecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiung-Ru Lai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynaecology, Division of Gynaecology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
39
|
Neuroendocrine Neoplasms of the Gynecologic Tract. Cancers (Basel) 2022; 14:cancers14071835. [PMID: 35406607 PMCID: PMC8998008 DOI: 10.3390/cancers14071835] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 01/11/2023] Open
Abstract
Simple Summary Neuroendocrine refers to the cells that synthesize and secrete messenger chemicals such as neuropeptides and amines. Neuroendocrine neoplasms (NENs) are aggressive tumors arising from neuroendocrine cells, with an annual incidence of 6.98/100,000 and a prevalence of 170,000 in the United States. Primary gynecologic NENs constitute ≤2% of female reproductive tumors. NENs of the gynecologic tract are associated with high recurrence rates and dismal prognosis, making their treatment challenging. This article focuses on the updated staging classifications, clinicopathological characteristics, imaging, and management of NENs of the gynecological tract. Abstract Gynecological tract neuroendocrine neoplasms (NEN) are rare, aggressive tumors from endocrine cells derived from the neuroectoderm, neural crest, and endoderm. The primary gynecologic NENs constitute 2% of gynecologic malignancies, and the cervix is the most common site of NEN in the gynecologic tract. The updated WHO classification of gynecologic NEN is based on the Ki-67 index, mitotic index, and tumor characteristics such as necrosis, and brings more uniformity in the terminology of NENs like other disease sites. Imaging plays a crucial role in the staging, triaging, restaging, and surveillance of NENs. The expression of the somatostatin receptors on the surface of neuroendocrine cells forms the basis of increasing evaluation with functional imaging modalities using traditional and new tracers, including 68Ga-DOTA-Somatostatin Analog-PET/CT. Management of NENs involves a multidisciplinary approach. New targeted therapies could improve the paradigm of care for these rare malignancies. This article focuses on the updated staging classifications, clinicopathological characteristics, imaging, and management of gynecologic NENs of the cervix, ovary, endometrium, vagina, and vulva, emphasizing the relatively common cervical neuroendocrine carcinomas among these entities.
Collapse
|
40
|
Zhang W, Chen Q. Primary ovarian carcinoid arising in associated mature cystic teratoma. BMC Womens Health 2022; 22:76. [PMID: 35300659 PMCID: PMC8932059 DOI: 10.1186/s12905-022-01660-x] [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] [Received: 07/20/2021] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary ovarian carcinoid is a very rare ovarian low-grade neuroendocrine tumor, accounting for about 0.1% of all ovarian neoplasms. CASE PRESENTATION We reported a case of primary ovarian carcinoid arising from a mature cystic teratoma in a 50-year-old woman. Intraoperative frozen section of left ovarian mass was assessed and a malignant epithelial tumor was considered. Morphologically, the main tumor was composed of cells forming trabeculae, and mature cystic teratoma was observed adjacent to the main part. Immunohistochemistry revealed that the trabecular cells were diffuse positive for pan Cytokeratin, CD56 and synaptophysin with low Ki-67 index (about 1%). CONCLUSIONS Careful morphological observation combined with appropriate accessory examination are essential for the diagnosis of primary ovarian carcinoid arising from mature cystic teratoma. In addition, the classification criteria of the primary ovarian neuroendocrine tumor are discussed.
Collapse
Affiliation(s)
- Wanyu Zhang
- Department of Pathology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei Province, People's Republic of China
| | - Qiongrong Chen
- Department of Pathology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei Province, People's Republic of China.
| |
Collapse
|
41
|
Uterine carcinoma admixed with neuroendocrine carcinoma. GINECOLOGIA.RO 2022. [DOI: 10.26416/gine.38.4.2022.7391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
42
|
Emerging Therapeutic Concepts and Latest Diagnostic Advancements Regarding Neuroendocrine Tumors of the Gynecologic Tract. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121338. [PMID: 34946283 PMCID: PMC8703600 DOI: 10.3390/medicina57121338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 12/21/2022]
Abstract
Neuroendocrine neoplasms (NENs) are particularly rare in all sites of the gynecological tract and include a variety of neoplasms with variable prognosis, dependent on histologic subtype and site of origin. Following the expert consensus proposal of the International Agency for Research on Cancer (IARC), the approach in the latest World Health Organization (WHO) Classification System of the Female Genital Tumours is to use the same terminology for NENs at all body sites. The main concept of this novel classification framework is to align it to all other body sites and make a clear distinction between well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). The previous WHO Classification System of the Female Genital Tumours featured more or less the same principle, but used the terms ‘low-grade neuroendocrine tumor’ and ‘high-grade neuroendocrine carcinoma’. Regardless of the terminology used, each of these two main categories include two distinct morphological subtypes: NETs are represented by typical and atypical carcinoid and NEC are represented by small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC). High-grade NECs, especially small cell neuroendocrine carcinoma tends to be more frequent in the uterine cervix, followed by the endometrium, while low-grade NETs usually occur in the ovary. NENs of the vulva, vagina and fallopian tube are exceptionally rare, with scattered case reports in the scientific literature.
Collapse
|
43
|
Hou W, Zhou B, Hou G, Pang Y, Sang J, Li N. Small cell neuroendocrine carcinoma expressing alpha fetoprotein in the endometrium. Open Life Sci 2021; 16:1219-1224. [PMID: 34805530 PMCID: PMC8580041 DOI: 10.1515/biol-2021-0122] [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] [Received: 08/02/2021] [Revised: 09/18/2021] [Accepted: 09/25/2021] [Indexed: 11/15/2022] Open
Abstract
Rare small cell neuroendocrine carcinoma (SCNEC) cases showed alpha fetoprotein (AFP) expression in the endometrium. In this study, we reported a case of uterine SCNEC expressing AFP. In addition, a literature review was performed to investigate the potential mechanism and the clinicopathological features of SCNEC to provide clinical guidance. A 65-year-old female was referred to our hospital due to vaginal bleeding for 1 month in November 2020. The clinical features were summarized. After total hysterectomy and removal of bilateral appendages, the histological examination and immunohistochemistry examination were performed. Histological findings showed that the cancer cells were arranged in a nest-like pattern distributed in a lamellar manner. The smooth muscles of the uterus were invaded by cancer cells. Cancer cells were relatively consistent in size. Small glandular duct-like and rosettes-like structures were distinguished, together with necrotic tissues. The deep staining showed that the amount of cytoplasm was lower in the nucleus. Partial cancer cells had small nucleolus with an irregular profile. There were some mitotic figures. Immunohistochemistry examination indicated that there was a diffuse expression of CK, Syn, CgA, CD56, CK8/18, P16, AFP, HepPar-1, Glypican-3, and Ki67 (90%). In this case, we reported a SCNEC patient expressing AFP, Glypican-3, and HepPar-1.
Collapse
Affiliation(s)
- Weiwei Hou
- Department of Pathology, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| | - Bin Zhou
- Traditional Chinese Medicine Gynecology Department, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| | - Gang Hou
- Department of Pathology, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| | - Yu Pang
- Department of Pathology, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| | - Jing Sang
- Department of Pathology, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| | - Ning Li
- Department of Pathology, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| |
Collapse
|
44
|
Yang XL, Guan WJ, Kou LN, Wang MM, Lai H, Wu DJ. A real-world, population-based study of the trends for incidence and prognosis in high-grade neuroendocrine tumor of cervix. Curr Probl Cancer 2021; 46:100800. [PMID: 34838343 DOI: 10.1016/j.currproblcancer.2021.100800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
To explore the incidence and prognosis trends for high-grade cervical neuroendocrine tumor (HGCNET) and construct a nomogram to predict prognosis for HGCNET. Annual age-adjusted incidence of HGCNET from 1975 to 2015 was retrieved from the Surveillance, Epidemiology, and End Results program, the linear regression, poisson regression and annual percentage changes were used to assess the incidence trend. Also, trends for relative survival (RS) and overall survival (OS) in HGCNET patients from 1975 to 2015 were evaluated. From 1988 to 1975, 514 HGCNET patients were selected and divided into two cohorts with a ratio of 7:3. Nomogram to predict OS for these patients was constructed and validated. The incidence trend for HGCNET was unchanged in the past four decades (P = 0.734), but the proportion of HGCNET in diagnosed cervical cancer slightly increased from 0.9% in 1975 to 1.9% in 2015 (P < 0.001). The 5-year RS and OS for HGCNET in the study periods decreased steadily (RS: P = 0.009; OS: P = 0.008). Nomogram incorporating age, T stage, lymph-node positive, distant metastasis and surgery was constructed. The C-index of the nomogram was 0.716 (0.680-0.752), which was higher than the FIGO staging system. The incidence of HGCNET remained unchanged in the past four decades but the proportion of HGCNET has slightly increased. Besides, a steadily decreasing survival for HGCNET was observed in the study periods. A nomogram was constructed to better predict prognosis for HGCNET.
Collapse
Affiliation(s)
- Xi-Lin Yang
- Department of Radiation Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wen-Ju Guan
- Department of Oncology, Chengdu Second People's Hospital, Chengdu, China
| | - Ling-Na Kou
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Ming-Ming Wang
- Department of Oncology, The first affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Hua Lai
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Da-Jun Wu
- Department of Radiation Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| |
Collapse
|
45
|
Pang L, Guo Z. Primary neuroendocrine tumors of the ovary: Management and outcomes. Cancer Med 2021; 10:8558-8569. [PMID: 34773393 PMCID: PMC8633223 DOI: 10.1002/cam4.4368] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 12/19/2022] Open
Abstract
Background There is currently no recognized first‐line treatment strategy for ovarian neuroendocrine tumors (NETs). Furthermore, because of the low incidence of ovarian NETs, no studies have reported prognostic statistics derived from large samples. This retrospective study aimed to investigate the clinical behavior of ovarian NETs. Methods The Surveillance, Epidemiology, and End Results database was used to identify women diagnosed with ovarian NETs from 2004 to 2015. Overall survival (OS), cancer‐specific survival (CSS), and independent prognostic factors for ovarian NETs were evaluated. The effects of different treatments on prognosis were also compared, as were OS and CSS rates for histological subtypes. Results The 5‐year OS rates were 83.3%, 30.0%, 20.3%, and 9.8% for patients in stages I (n = 159), II (n = 23), III (n = 101), and IV (n = 148), respectively. The 5‐year CSS rates were 85.6%, 41.7%, 21.2%, and 9.8% for patients in stages I–IV, respectively. Age, American Joint Committee on Cancer (AJCC) stage, lymph node metastasis, treatment, and histological type were related to poor OS and CSS. In the early stage, the 5‐year OS and CSS rates were 97.03% and 96.90%, respectively. For patients in the advanced stage receiving comprehensive treatment (surgery + chemotherapy + radiotherapy), the 5‐year OS and CSS rates were 72.9% and 70.00%, respectively. When comparing low‐ and high‐grade neuroendocrine carcinoma, 5‐year OS rates were 93.96% and 7.01%, 5‐year CSS rates were 97.44% and 7.31%, 10‐year OS rates were 93.56% and 2.34%, and 10‐year CSS rates were 97.44% and 4.88%, respectively. Conclusion Age, AJCC stage, treatment, and histological type are independent prognostic factors of ovarian NETs. OS and CSS are relatively good for early‐stage cases treated with surgery alone, whereas more comprehensive treatment is required to improve OS and CSS in the advanced stage.
Collapse
Affiliation(s)
- Li Pang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhiqiang Guo
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
46
|
Rastegar S, Heller DS. Nonsquamous Lesions of the Vulvar Skin and Subcutaneous Tissue: A Review (Part 1). J Low Genit Tract Dis 2021; 25:303-311. [PMID: 34542086 DOI: 10.1097/lgt.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This article aimed to review "nonsquamous lesions of the vulvar skin and subcutaneous tissue" clinically and pathologically, based on the fifth edition of the World Health Organization tumor classification. MATERIALS AND METHODS A database search of PubMed and Google Scholar was performed between 1970 and 2021, using the search terms "vulva," "lower genital tract," and "nonsquamous lesions." The search was limited to "humans," "gynecopathology," and "dermatopathology." Full article texts were reviewed. Reference lists were screened for additional articles. We excluded articles written in the non-English language and abstracts. RESULTS A list of 600 articles was identified. Another screening identified 68 articles for clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue. In the first part of this review, we cover 5 major groups of nonsquamous lesions of the vulvar skin and subcutaneous tissue including (1) glandular tumors and cysts, (2) adenocarcinomas of other types, (3) germ cell tumors of the vulva, (4) neuroendocrine neoplasia, and (5) hematolymphoid hyperplasia and neoplasia. The rest of the major topics including mesenchymal tumors of the lower genital tract, melanocytic lesions, and metastasis will be discussed in the second part of this review. CONCLUSIONS Clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue as categorized by the updated World Health Organization classification are presented.
Collapse
Affiliation(s)
- Shima Rastegar
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
| | | |
Collapse
|
47
|
Clinicopathological Analysis of Neuroendocrine Carcinoma of the Uterine Cervix: A Single-Institution Retrospective Review of 9 Cases. Int J Surg Oncol 2021; 2021:8290659. [PMID: 34567803 PMCID: PMC8463196 DOI: 10.1155/2021/8290659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/28/2021] [Indexed: 12/05/2022] Open
Abstract
Aim To evaluate the clinicopathological features affecting the recurrence and survival of 9 cases of neuroendocrine cancer of the cervix. Method We retrospectively analyzed 9 cervical neuroendocrine cancer cases identified among 453 cervical cancer patients between 2004 and 2021 at Akdeniz University Gynecological Oncology Outpatient Clinic. Kaplan–Meier survival analysis was used for progression-free survival (PFS) and overall survival (OS). Mathematical functions of mean, standard deviation, median, Min–Max values, and frequencies were used for descriptive statistics. The categorical data were expressed in numbers and percentages (%). Results Nine patients with neuroendocrine histological subtype were selected out of 453 patients diagnosed with cervical cancer (1.98%). The average overall survival time of the patients was 26 months. The 5-year survival rate was 53.3%, while the PFS was 62.5%. The most common subtype was small cell neuroendocrine cancer. Tumours were mostly locally advanced at the time of diagnosis. 3 patients' stage was 1b2, while 4 patients were 2b, 1 patient was 3c2r, and 1 patient was 4b. All tumours showed the immunohistochemical staining properties of neuroendocrine cancer. The main treatment modality applied to our patients was surgery + adjuvant CRT. The most used chemotherapeutic agents were cisplatin/carboplatin and etoposide. Recurrence was found in 3 cases, including 5 deaths. Conclusion Neuroendocrine tumour of the cervix is a rare subtype with a poor prognosis. Unfortunately, there is not yet a standard treatment protocol due to the limited number of comparative studies of surgery, chemotherapy, and radiotherapy based treatment schemes.
Collapse
|
48
|
Kawamura M, Koide Y, Murai T, Ishihara S, Takase Y, Murao T, Okazaki D, Yamaguchi T, Uchiyama K, Itoh Y, Kodaira T, Shibamoto Y, Mizuno M, Kikkawa F, Naganawa S. The importance of choosing the right strategy to treat small cell carcinoma of the cervix: a comparative analysis of treatments. BMC Cancer 2021; 21:1046. [PMID: 34556082 PMCID: PMC8461987 DOI: 10.1186/s12885-021-08772-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 09/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Standard treatments for small cell carcinoma of the cervix (SCCC) have not been established. In this study, we aimed to estimate the optimal treatment strategy for SCCC. Methods This was a multicenter retrospective study. Medical records of patients with pathologically proven SCCC treated between 2003 and 2016 were retrospectively analyzed. Overall survival (OS) was plotted using the Kaplan-Meier method. Log-rank tests and Cox regression analysis were used to assess the differences in survival according to stage, treatment strategy, and chemotherapy regimen. Results Data of 78 patients were collected, and after excluding patients without immunohistopathological staining, 65 patients were evaluated. The median age of the included patients was 47 (range: 24–83) years. The numbers of patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stages I-IIA, IIB-IVA, IVB were 23 (35%), 34 (52%), and 8 (12%), respectively. Of 53 patients who had undergone chemotherapy, 35 and 18 received SCCC and non-SCCC regimens as their first-line chemotherapy regimen, respectively. The 5-year OS for all patients was 49%, while for patients with FIGO stages I-IIA, IIB-IVA, IVB, it was 60, 50, and 0%, respectively. The 5-year OS rates for patients who underwent treatment with SCCC versus non-SCCC regimens were 59 and 13% (p < 0.01), respectively. This trend was pronounced in locally advanced stages. Multivariate analysis showed that FIGO IVB at initial diagnosis was a significant prognostic factor in all patients. Among the 53 patients who received chemotherapy, the SCCC regimen was associated with significantly better 5-year OS in both the uni- and multivariate analyses. Conclusion Our results suggest that the application of an SCCC regimen such as EP or IP as first-line chemotherapy for patients with locally advanced SCCC may play a key role in OS. These findings need to be validated in future nationwide, prospective clinical studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08772-x.
Collapse
Affiliation(s)
- Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shunichi Ishihara
- Department of Radiology, Toyohashi Municipal hospital, Toyohashi, Japan
| | - Yuuki Takase
- Department of Radiology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Takayuki Murao
- Department of Radiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Dai Okazaki
- Department of Radiology, Okazaki City Hospital, Okazaki, Japan
| | | | - Kaoru Uchiyama
- Department of Radiology, Kariya-Toyota General Hospital, Kariya, Japan
| | - Yoshiyuki Itoh
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mika Mizuno
- Department of Obstetrics and Gynecology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, Aichi, 466-8550, Japan
| |
Collapse
|
49
|
Bain E, Coleridge SL, Morrison J. Small cell neuroendocrine tumour of the cervix in pregnancy: the importance of multidisciplinary management. BMJ Case Rep 2021; 14:e237058. [PMID: 34518171 PMCID: PMC8438837 DOI: 10.1136/bcr-2020-237058] [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] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
A woman in her mid-20s presented with bleeding at 18 weeks gestation from a cervical 'polyp'. Histopathology demonstrated a rare small cell neuroendocrine of the cervix. There were only 18 cases of neuroendocrine tumours of the cervix in and around pregnancy in the literature, so the evidence base for treatment was scarce. She was treated with neoadjuvant chemotherapy, using a regimen used for small cell neuroendocrine tumours of the lung, to allow for fetal lung maturity. Disease initially responded, then progressed and she was delivered at 32 weeks by caesarean radical hysterectomy. Adjuvant treatment included further chemotherapy and radical pelvic radiotherapy. The woman and her child are doing well over 6 years after treatment, although the woman has significant side effects of both radical surgery and radiotherapy. This case emphasises the need for excellent communication between multidisciplinary professionals, patients and their families and using external colleagues to help with rare clinical problems.
Collapse
Affiliation(s)
- Esme Bain
- Obstetrics and Gynaecology, Somerset NHS Foundation Trust, Taunton, UK
| | - Sarah Louise Coleridge
- Department of Gynaecological Oncology, Somerset NHS Foundation Trust, Taunton, UK
- Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jo Morrison
- Department of Gynaecological Oncology, Somerset NHS Foundation Trust, Taunton, UK
| |
Collapse
|
50
|
Yan F, Zhou Q, Lin Y, Yu C, Chang H, Li Y. Clinicopathological analysis of primary carcinoid tumour of the ovary arising in mature cystic teratomas. J Int Med Res 2021; 49:3000605211034666. [PMID: 34459278 PMCID: PMC8408898 DOI: 10.1177/03000605211034666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the clinicopathological features, diagnosis and differential diagnosis of patients with primary ovarian carcinoid tumours arising in mature cystic teratomas. METHODS This retrospective case series analysed the data from patients with primary ovarian carcinoid tumours arising in mature cystic teratomas. RESULTS The study enrolled four patients. Histopathological analysis of the tumours identified the following subtypes: insular (n = 1), trabecular (n = 1) and strumal (n = 2). All four primary ovarian carcinoid tumours originated from a mature teratoma. The morphology of the primary ovarian carcinoids was similar to other neuroendocrine tumours. Strumal carcinoids were composed of different proportions of thyroid tissue intimately admixed with carcinoid tumour. Tumour tissue was arranged in insular and/or trabecular patterns. The nucleus of tumour cells displayed exquisite chromatin without obvious mitotic figures. Tumour tissues were positively stained for neuroendocrine markers chromogranin A, synaptophysin and CD56 to varying degrees. Strumal carcinoid tumours were cytokeratin 19 positive and thyroid transcription factor 1 negative. No recurrence or metastasis occurred during follow-up (12-71 months). CONCLUSION Primary ovarian carcinoid tumours arising in mature cystic teratomas are rare. Diagnosis and differential diagnosis should be confirmed by clinical features, histopathological characteristics and specific immunophenotyping.
Collapse
Affiliation(s)
- Fengcai Yan
- Department of Pathology, 117968Beijing Shijitan Hospital, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Quan Zhou
- Department of Pathology, 117968Beijing Shijitan Hospital, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yulin Lin
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chunkai Yu
- Department of Pathology, 117968Beijing Shijitan Hospital, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hong Chang
- Department of Pathology, 117968Beijing Shijitan Hospital, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|