Adenocarcinoma in situ admixed with small cell neuroendocrine carcinoma of the cervix: A case report with cytological features

Abstract

Primary cervical small cell neuroendocrine carcinoma (SCNEC) is a rare and aggressive tumor. Herein, we describe the first cytological case of adenocarcinoma in situ (AIS) admixed with SCNEC. A 65-year-old postmenopausal Japanese female presented with abnormal genital bleeding. The Papanicolaou smear of the cervix demonstrated the presence of 2 distinct neoplastic components in an inflammatory background. One component consisted of aggregates of small round cells with a high nuclear/cytoplasmic ratio and round to oval nuclei with powdery chromatin, and inconspicuous nucleoli. Nuclear molding was characteristic. The other component consisted of irregular overlapping clusters of tall columnar cells with large round to oval nuclei containing coarse chromatin, and relatively rich cytoplasm. Accordingly, AIS admixed with SCNEC was suspected. Although the cytological features of cervical SCNEC are characteristic, the cytodiagnosis of this type of tumor may be difficult because of the rarity of the tumor. The presence of non-neuroendocrine tumor components in cervical SCNEC is not unusual, therefore careful observation is needed not to miss SCNEC components in the diagnosis of squamous cell carcinoma and/or adenocarcinoma in cervical cytological specimens.

Small‐cell neuroendocrine carcinoma of the cervix accompanied by adenocarcinoma and high‐grade squamous intraepithelial lesion

“…Thus, the presence of adenocarcinoma (invasive or in situ), squamous cell carcinoma, or HSIL is predictable. Immunoreactivity for p16, indicating a high‐risk for HPV infection, is observed in a majority of cervical SCNEC cases 8–12 . The present case may have a high‐risk HPV infection, since p16 was expressed diffusely in all three components: SCNEC, adenocarcinoma, and HSIL.…”

“…Cytological features of cervical SCNEC are reported to be similar to that of other organs, including the lungs, however, a cytological diagnosis is challenging because of its rarity. 1,[10][11][12][13][14] Although an accurate incidence has not been established, cervical SCNEC may have squamous cell carcinoma and/or adenocarcinoma components. [6][7][8][9] In the present case, the cytological features of adenocarcinoma and HSIL were typical.…”

“…Immunoreactivity for p16, indicating a high-risk for HPV infection, is observed in a majority of cervical SCNEC cases. [8][9][10][11][12] The present case may have a high-risk HPV infection, since p16 was expressed diffusely in all three components: SCNEC, adenocarcinoma, and HSIL.…”

“…The accuracy of cytological diagnosis of cervical SCNEC has been reported to be low 8,15 . This is mainly due to the rarity of cervical SCNECs 12 . Thus, cervical cytological specimens require a thorough cytological examination to detect SCNEC components when a cytological diagnosis of squamous cell carcinoma or HSIL and/or adenocarcinoma (invasive or in situ) is made; cervical SCNEC occasionally contains these components and shows aggressive clinical behavior 5 …”

Neuroendocrine carcinoma admixed adenocarcinoma of cervix: A case report of young female

“…1 Small cell carcinoma types are more common than other types, which is around 2% to 5% of all cervical cancers. 2 Some studies state that only 4% of small cell carcinomas are coexistent with adenocarcinoma. 3 This type of tumor has a poor prognosis and so far no standard treatment has been obtained for this type of tumor.…”