Neuroendocrine small cell carcinoma of the cervix: A case report

Abstract

Merkel cell polyomavirus (MCPyV) has been found in patients with Merkel cell carcinoma and respiratory tract infections. Merkel cell carcinoma is a primary aggressive neuroendocrine carcinoma of the skin. It has been demonstrated that MCPyV can be transmitted during sexual activity and may be present in the oral and anogenital mucosa. The aim of the present study was to evaluate whether MCPyV coexisted with HPV in three cases of neuroendocrine small cell carcinoma of the cervix using PCR and immunohistochemical analysis Three cases of NSC of the cervix were identified in the pathology archives of Parma University (Italy). Of these, two cases were associated with an adenocarcinomatous component. A set of general primers from the L1 region (forward, L1C1 and reverse, L1C2 or L1C2M) was PCR amplified to detect the broad-spectrum DNA of genital HPV. The presence of MCPyV was investigated via immunohistochemistry using a mouse monoclonal antibody against the MCPyV LT antigen and through PCR analysis to separate viral DNA. HPV DNA was present in all three neuroendocrine carcinomas and in the adenocarcinoma component of the two mixed cases. None of the cases were immunoreactive to CM2B4 and did not contain viral DNA in either their neuroendocrine or adenocarcinomatous component. Whilst it is difficult to draw definitive conclusions from such a small sample size, these data suggested that MCPyV does not coexist with HPV in the cervix. However, in the present study, the absence of detectable MCPyV may have been due to the presence of a genotype that was not detected by the primers used in the PCR analysis or by the antibody used for the immunohistochemical study. MCPyV microRNA may also have been present, inhibiting LT expression. Additional studies with larger cohorts and more advanced molecular biology techniques are required to confirm the hypothesis of the current study.

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

“…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. Therefore, our results indicate that the preoperative cytological diagnosis of SCNEC accompanied by adenocarcinoma and HSIL was possible.…”

“…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 1,10–14 . Although an accurate incidence has not been established, cervical SCNEC may have squamous cell carcinoma and/or adenocarcinoma components 6–9 . In the present case, the cytological features of adenocarcinoma and HSIL were typical.…”

“…A high-risk of HPV, in particular HPV-18 infection, is associated with the presence of cervical SCNEC. 7,9,10 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.…”

“…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.…”

“…1,2 While cervical SCNEC comprises 2-5% of all cervical cancers, [3][4][5] adenocarcinoma and/or squamous cell carcinoma components may be presented. [6][7][8][9] Here, we describe a case of cervical SCNEC accompanied by adenocarcinoma and high-grade squamous intraepithelial lesion (HSIL).…”