A case of small cell neuroendocrine carcinoma of the uterine cervix that could be diagnosed preoperatively by cytology

Abstract

Small cell neuroendocrine carcinoma (SCNEC) of the uterine cervix is a relatively rare, highly aggressive tumor. We report a case of SCNEC of the uterine cervix that could be diagnosed preoperatively by cytology. The patient was a woman in her 20s. Owing to persistent uterine bleeding, cervical smear cytology was performed. The cytological diagnosis was SCNEC based on cell cluster arrangement with no specific structure, nuclear molding, naked nuclei-like cells with scant cytoplasm, and finely granular nuclear chromatin. On the other hand, the presence of squamous cell carcinoma was also suspected from the cytologic findings of atypical cell clusters rich in cytoplasm and having large nuclei. The histological diagnosis was also SCNEC based on a concentrated proliferation of small single cells with a high N/C ratio. Subsequently, radical hysterectomy was performed, and immunohistochemical examination led to the final diagnosis of SCNEC with the squamous cell carcinoma component. The tumor in this case was 6 cm in diameter and was positive for para-aortic lymph node metastasis, but no recurrence or metastasis was observed for 36 months after surgery. The cytological diagnosis of SCNEC requires the presence of cell arrangement with no specific structure, nuclear molding, and finely granular nuclear chromatin.