Small Cell Neuroendocrine Carcinoma of the Cervix in Pregnancy: A Case Report and Review

Emergency Presentation of Invasive Cervical Cancer in Late Pregnancy: A Case Report and Literature Review

Antepartum hemorrhage (APH) often prompts consideration of the presence of obstetric disorders. Here, we describe a case with active APH in which invasive cervical cancer was the cause. A 41-year-old woman, fifth gravida, fourth para (G5, P4), presented to the emergency department at 38 weeks of gestation with an acute severe attack of vaginal bleeding, which occurred immediately after a per-vaginal examination at another local institute. Despite initial stabilization measures and investigations to exclude common causes of APH, a protruding cervical mass was discovered during a Cusco speculum examination. The patient underwent an emergent cesarean section (CS). Postoperatively, the patient was referred to the gynecological oncology unit for further evaluation and management. Magnetic resonance imaging (MRI) confirmed the presence of a large cervical mass. A punch biopsy revealed squamous cell carcinoma (SCC) of the cervix. All these confirmed the condition as cervical carcinoma stage IB3. This case and literature review highlight the obstacles that might delay the diagnosis of cervical cancer and the importance of continuing the screening program strategies even during pregnancy to avoid complications of invasive cervical cancer. In addition, bleeding due to cervical cancer should always be considered one of the important differential diagnoses of APH even in full-term pregnancy.

Small cell neuroendocrine tumour of the cervix in pregnancy: the importance of multidisciplinary management

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.

Small-Cell Carcinoma of the Uterine Cervix Discovered With Quadriplegia Caused by Cervical Spine Metastasis

Small-cell carcinoma of the uterine cervix is a rare and aggressive tumor, and the prognosis is poor compared with those of squamous cell carcinoma and adenocarcinoma of the uterine cervix, even when discovered at an earlier stage. We treated a patient with progressive small-cell carcinoma of the uterine cervix that metastasized to the cervical spine. The patient, a 73-year-old woman, presented with the symptom of numbness in her limbs. As she had difficulty moving her limbs (ie, quadriplegia), she was carried to an emergency room. A metastatic cervical spine tumor from the uterine cervical cancer was revealed by a computed tomography scan, and the patient was then transferred to our hospital's neurosurgery department for treatment. We performed a resection of the cervical spine tumor and fixation of the spinal bone. Because the patient's performance status was 4 and she remained bedridden 24 h/day, we could not perform systemic chemotherapy. We thus provided palliative care, including palliative radiotherapy, pain control, and rehabilitation to improve her limbs' functioning. The patient died of the uterine cancer within approx. 6 months after the initiation of treatment. There is no established treatment for small-cell carcinoma as a gynecological lesion. For patients with progressive uterine cancer, the optimal treatments, including palliative care, must be determined.