Small Cell Carcinoma of the Uterine Cervix Misdiagnosed as Squamous Cell Carcinoma

Abstract

Small cell carcinoma of the uterine cervix is a rare tumor. It presents clinical and biological features of both cervical neoplasm such as local aggressiveness, and small cell cancer such as early spread and metastases. To date, an effective treatment protocol is not well established. Case: On March 2009, a 44-year-old pregnant woman with small cell carcinoma of the cervix misdiagnosed initially as squamous cell carcinoma, was treated with chemoradiation followed by surgery and brachytherapy. Twenty-three months later, she experienced brain metastases. A metastasectomy lead to an accurate diagnosis. Palliative whole brain radiotherapy was conducted. The patient died of evolutive disease on August 2012. Conclusion: The optimal therapeutic approach of small cell carcinoma of the cervix is still to define. Further studies regarding multimodal treatment are necessary to achieve a significant survival benefit.Keywords: uterine cervix, small cell carcinoma, treatment IntroducationSmall-cell neuroendocrine cervical carcinoma (SCNCC) is a rare malignancy that represents less than 5% of all cervical malignancies (Conner, 2002;Abeler, 1994). Its histology and clinical behavior are comparable to that of small cell carcinoma (SCC) of the lung (Korcum, 2008). SCNCC is characterized by an aggressive clinical course and poor prognosis due to the high incidence of lymphatic involvement and hematogenous dissemination occurring at an early stage (Korcum, 2008;Abeler, 1994;Hoskins, 1995). Therefore, the prognosis of SCNCC is worse when compared to the other cervical malignancies. The treatment is based on surgery, radiotherapy and chemotherapy either alone or in combination (Korcum, 2008;Huang, 2006), but a standard treatment protocol is still to define due to the rarity of this entity. Herein, we report a case of SCNCC misdiagnosed initially as squamous cell carcinoma, and review and discuss the clinical course and the modalities of treatment. CaseOn March 2009, a 44-year-old woman presented with abnormal vaginal bleeding at 29 weeks pregnant. Her past medical history was not significant, and she had never undergone a Pap smear. On gynecologic examination, a mass was noted on the cervix about 5 cm in size with contact bleeding. The parametrium and pelvic sidewalls were normal. A cervical biopsy demonstrated squamous cell carcinoma of the uterine cervix. A complete workup including cystoscopy, proctosigmoidoscopy and chest X-ray did not show any other abnormal findings. According to the 2002 FIGO staging system, the tumor was classified as stage IB2. The patient underwent cesarean delivery at 34 weeks of pregnancy, and then she received concomitant radio-chemotherapy (1.8 Gy/day, total 45 Gy with weekly cisplatin 40 mg/m²) followed by radical colpo-hysterectomy with pelvic and para-aortic lymph node clearance. The resected specimen was clear of residual tumor.Following surgery, vaginal barchytherapy was administered using the high-dose-rate brachytherapy. The treatment was well tolerated with no significant side effects.