Neuroendocrine small cell carcinoma of the cervix associated with endocervical adenocarcinoma: a case report.
BACKGROUND
Small-cell carcinoma (SCC) of the cervix is an uncommon member of the neuroendocrine group of cervical carcinomas that is frequently intermixed with a non-SCC component in the form of an adenocarcinoma (ADC) or squamous carcinoma.


METHODS
Colposcopy revealed a cervical mass in a 41-year-old woman and a Pap smear the presence of some tumor cells from SCC, which was confirmed by subsequent biopsy. The patient received 3 cycles of chemotherapy and then underwent major surgery. The cervical samples showed areas of endocervical ADC adjacent to and intermixed with the SCC. Reviewing the Pap smear, a previously missed malignancy was recognized. On subsequent molecular investigation to assess clonality by microsatellite analysis, the presence of HR-HPV DNA18 on real-time polymerase chain reaction, p16(INK4a) fluorescence in situ hybridization status and the corresponding immunohistochemical expression supported the hypothesis that the two components of the tumor shared the same cell origin.


CONCLUSIONS
SCC of the cervix is a rare but distinct HR-HPV-18-related cervical carcinoma often intermixed with a clonally related non-small cell component consisting of an ADC or squamous carcinoma. The presence of SCC tumor cells in a cervical smear should prompt a search for malignant glandular or squamous tumor cells.
Alphandery
Claudia
C
Department of Pathology and Experimental Molecular Pathology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
Dagrada
Gianpaolo
G
Frattini
Milo
M
Perrone
Federica
F
Pilotti
Silvana
S
D000328:Adult; D001706:Biopsy; D019002:CD56 Antigen / Q000378:metabolism; D018288:Carcinoma, Small Cell / Q000473:pathology*; D002584:Cervix Uteri / Q000473:pathology; D053379:Chromogranin A / Q000378:metabolism; D002886:Chromosomes, Human, Pair 17 / Q000235:genetics; D002887:Chromosomes, Human, Pair 18 / Q000235:genetics; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000378:metabolism; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D018895:Microsatellite Repeats / Q000235:genetics; D018358:Neuroendocrine Tumors / Q000473:pathology*; D065006:Papanicolaou Test; D016708:Synaptophysin / Q000378:metabolism; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears
D019002:CD56 Antigen; D053379:Chromogranin A; D019941:Cyclin-Dependent Kinase Inhibitor p16; D016708:Synaptophysin