Small cell (neuroendocrine) carcinoma of the vagina

Small Cell Carcinoma of the Vagina: First Systematic Review of Case Reports and Proposal of a Management Algorithm

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.

Neuroendocrine carcinoma of vagina with prolonged survival

We report the case of a woman in her 70s with a stage IVA small cell neuroendocrine carcinoma of the vagina. The patient started chemotherapy with cisplatin and etoposide followed by concurrent chemoradiotherapy and adjuvant chemotherapy. Pelvic MRI after completion of treatment did not show residual disease. Three years and 8 months after definitive treatment, the patient remains on regular follow-up without evidence of disease.

Small cell neuroendocrine carcinoma of vagina: Report of a unique case with literature review

Small cell carcinoma (SCC) of vagina is extremely rare. The association between this tumor and high-risk HPV infection is unclear. To our knowledge, HPV status has been reported in only 3 previous cases of SCC of vagina. Herein, we present a unique case of vaginal small cell carcinoma with discordant HPV testing results between vaginal and cervical samples. We also review and discuss findings from previously reported cases of small cell carcinoma of vagina.

Primary small cell carcinoma of the vagina: a rare instance of prolonged survival

Small cell carcinoma (SmCC) of the vagina is a rare and aggressive tumour. It comprises only 1% -2% of all gynaecological malignancies 85% of the patients with SmCC vagina die within a year of diagnosis. Here we report the case of a 65-year-old woman with stage III primary neuroendocrine carcinoma of vagina who was treated with chemoradiotherapy. The patient survived 1 year and 10 months after the initial presentation. SmCC of the vagina is very rare and despite being aggressive, the local disease can be controlled with a chemoradiation regimen.

Primary Small Cell Neuroendocrine Carcinoma of the Vagina: A Clinicopathologic Study

Context.—Primary small cell neuroendocrine carcinoma of the vagina is extremely rare, and its clinical behavior is aggressive. To our knowledge, 22 patients with this tumor have been reported in the English literature to date.

Objective.—To investigate 3 patients with this tumor clinically and pathologically.

Design.—The pathology database at the University of Texas Medical Branch at Galveston was searched, and 3 cases of primary small cell neuroendocrine carcinoma of the vagina were found. The histologic, immunohistochemical, and ultrastructural profiles of the tumors were investigated. The medical charts of the patients were reviewed, and the patients were followed up.

Patients.—Women with the diagnosis of primary small cell neuroendocrine carcinoma of vagina.

Results.—All 3 patients presented with advanced disease, and 2 patients died within 4 months of the initial diagnosis. One 38-year-old patient was newly diagnosed, and her clinical outcome had not yet been determined. The histologic features of all 3 tumors were similar to those of their pulmonary counterpart. All cases were positive for cytokeratin, chromogranin A, and synaptophysin. The expression pattern of thyroid transcription factor 1 was examined in all 3 patients, of whom 2 were negative and 1 was positive with negative clinical and radiologic thyroid or pulmonary findings. Ultrastructural evaluation showed scattered intracytoplasmic electron-dense neurosecretory granules.

Conclusion.—Primary small cell neuroendocrine carcinoma of the vagina has histologic, immunohistochemical, and ultrastructural features similar to those of its pulmonary counterpart. Because thyroid transcription factor 1 can be positive, it should not be used to differentiate primary from metastatic disease. The current therapies have usually resulted in poor outcomes, and new therapeutic modalities should be explored.

Primary Ewing's sarcoma–primitive neuroectodermal tumor of the vagina

BACKGROUND

Only three cases of Ewing's sarcoma-primitive neuroectodermal tumor (ES-PNET) occurring in the vagina have been previously reported.

CASE

A 30-year-old Chinese woman presented with a vaginal mass measuring 5 cm in greatest dimension. The tumor was composed of solid sheets of undifferentiated small round cells with numerous Homer-Wright rosettes. Immunohistochemically, it was positive for CD99, FlI-1 protein, synaptophysin, neuron-specific enolase, vimentin, and S-100 protein. The patient underwent wide local excision of the tumor and subsequent total abdominal hysterectomy with postoperative chemotherapy and radiotherapy. She is disease-free 36 months after the initial surgery.

CONCLUSION

This is a rare case of ES-PNET occurring in the vagina and the first showing many distinctive Homer-Wright rosettes. A review of literature indicates that vaginal or vulvar ES-PNET affects younger women, and it may have a relatively favorable outcome.

Primary small cell carcinoma of the vagina

BACKGROUND

Primary vaginal small cell carcinoma is extremely rare, with a total number reported in English-language journals to date of 23. Most patients die of the disease within 2 years of diagnosis from metastatic disease.

CASE

A 69-year-old woman presented with vaginal spotting while on Premarin. She was subsequently diagnosed with Stage I (T1N0M0) small cell carcinoma of the vagina. She underwent concurrent chemoradiation and then brachytherapy for persistent disease. Due to residual disease after the brachytherapy, surgical resection was planned but aborted because of metastatic disease.

CONCLUSIONS

Of the three reported cases treated with concurrent chemoradiation, ours is the first case reported with persistent local disease after therapy. Extrapolating from the available clinical trials from lung carcinoma, concurrent chemoradiation as a primary treatment approach should still be considered.

Imaging of the vagina and vulva

The imaging evaluation of female lower genital tract cancers has undergone dramatic changes in the last two decades. Technical improvements and increased availability of cross-sectional modalities (US, CT, MR) have increased their use to such an extent that they have largely replaced more conventional imaging techniques. US is of limited value in the staging of vaginal and vulvar malignancies. CT is most useful for staging more advanced disease of the vagina and vulva. It is widely available and provides quick imaging time. CT is used in the detection and biopsy of suspected lymph nodes and metastases. MRI provides the best soft tissue contrast and is the most useful imaging modality available to evaluate carcinomas of the vagina and vulva. Future advancements in the imaging evaluation of vaginal and vulvar cancers will likely focus on functional imaging.

Cytomorphology of small-cell (neuroendocrine) carcinoma on ThinPrep cytology as compared to conventional smears

Small-cell (neuroendocrine) carcinoma of the female genital tract is an uncommon, aggressive neoplasm that occurs most commonly in the cervix and rarely in the vagina. Although the cytologic findings have been reported on conventional smears, the cytologic diagnosis of primary vaginal small-cell carcinoma on ThinPrep material has not been previously reported. We present a case of a 46-yr-old woman who underwent cervical/vaginal biopsies as a result of abnormal cells seen on the ThinPrep Pap Test. Small to medium-sized cells with scant cytoplasm were present singly and in loose, cohesive clusters. Nuclear molding was noted in a few cellular groups. The differential diagnosis included a high-grade squamous intraepithelial lesion, small-cell (neuroendocrine) carcinoma, endometrial adenocarcinoma, and lymphoma. Subsequent tissue biopsies with immunohistochemical staining confirmed a diagnosis of small-cell carcinoma of the vagina. The cytologic features of small-cell (neuroendocrine) carcinoma on slides prepared by the ThinPrep Pap Test are discussed and compared to those on conventional cervicovaginal smears.

Small cell carcinoma of the vagina

A case of localized small cell neuroendocrine carcinoma of the vagina is reported. The patient was treated with concurrent chemoradiation with significant toxicity but obtained a complete response. Thirteen months after therapy the patient developed distant metastasis and died shortly thereafter. Review of the literature found that patients treated with local therapy alone had a shorter survival and died of systemic disease. As with small cell neuroendocrine carcinomas arising from other sites, systemic relapse remains an important issue that warrants combination therapies, although in pelvic sites this may be associated with an increase in side-effects.

Pathology of APUDomas

The pathology of APUDomas involves two main areas. The first is the biochemical aspects of these tumours and the use of biochemical tests to investigate a patient suspected of having an APUDoma, and the other is the histopathology of these tumours. This review is devoted to the histopathological considerations.