Large cell neuroendocrine carcinoma of the uterine cervix with neuroendocrine tumor cells in the ascitic fluid

Abstract

Background : Large cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is rare, accounting for about 0.5% of all cervical tumors, and it carries a poor prognosis. The rate of positive ascitic fluid cytology in cases of cervical cancer reportedly ranges from 2.7% to 15.0%. Herein, we report a case of LCNEC of the uterine cervix in which a specimen could not be obtained from the uterine cervix, but neuroendocrine tumor cells were detected in the ascitic fluid.

Case : A 41-year-old nulliparous woman presented with abdominal distention and leg edema. Clinical examination revealed a tumor originating from the posterior wall of the lower uterine body and occupying the pelvis, and the uterine cervix was deviated toward the pubic bone. The patient also had a mental developmental disorder and schizophrenia. Cell and tissue specimens were obtained transvaginally. Cytology of the ascitic fluid collected at the time of laparoscopy showed arrangement of closely stacked tumor cells with well-defined nucleoli and fine granular chromatin. Immunohistochemistry of a biopsy specimen showed positive staining for INSM-1, p53, synaptophysin, and chromogranin A.

Conclusion : Although transvaginal specimen collection from the uterine cervix was not possible, cytology of the ascitic fluid and immunohistochemical staining of the tumor tissue proved useful for the diagnosis of uterine cervical LCNEC in our case.