2020 Volume 23 Issue 1 Pages 27-39
Neuroendocrine tumors of the uterine cervix have a poor prognosis, and lead to lymph node and distant metastases even at an early stage. Due to the rarity of these tumors (1 to 2% of cervical invasive cancers), it is difficult to construct therapeutic strategies based on prospective clinical trials. Cervical adenocarcinoma also has a poorer prognosis than squamous cell carcinoma, and there is limited evidence for a therapeutic approach. In this report, we present the case of a patient with stage IB2 cervical cancer, which consisted of both adenocarcinoma and neuroendocrine tumor elements. The patient underwent radical hysterectomy following 2 cycles of paclitaxel and carboplatin (TC) therapy as neoadjuvant chemotherapy. A 38-year-old woman, gravida 2, parity 2, with no noteworthy past or family history, presented with a 2-month history of increased mucous discharge with abnormal odor. The entire cervix was swollen and malignant lesions were observed in the anterior vaginal fornix and in the 5 o'clock direction in the cervix. Tissue biopsy of the former lesion showed endocervical adenocarcinoma, usual type with an abnormal tubular or papillary structure, while the latter lesion showed sheet-like to alveolar growth of strongly atypical cells, indicating it to be large cell neuroendocrine carcinoma. On pelvic contrast-enhanced MRI, two masses with different internal properties, contrast effects, and diffusion capacity were present next to each other. Contrast-enhanced CT of the chest to the pelvis demonstrated no swelling of the lymph nodes or distant metastases, but the tumor markers CEA (13.2 ng/mL) and CA19-9 (61.5 U/mL) had high values. Based on the diagnosis of stage IB2 cervical cancer, neoadjuvant chemotherapy was performed during the surgical waiting period. She received 2 cycles of TC therapy, and the tumor significantly decreased in size. Radical hysterectomy was performed, and histopathological examination of the removed uterus revealed the coexistence of CD56(+) and synaptophysin(+) components corresponding to neuroendocrine/atypical carcinoid tumors in the adenocarcinoma dominant lesions, some of which had migrated to each other. According to the 4th edition of the General Basis for Clinical and Pathological Management of Uterine Cervical Cancer, Pathological Edition, published in 2017, her tumor was classified into the adenocarcinoma admixed with neuroendocrine carcinoma category. The postoperative course was uneventful and additional 4 cycles of TC therapy were performed. There is a report that neoadjuvant chemotherapy for uterine cervical cancer may prolong survival. On the other hand, effective chemotherapy for cervical neuroendocrine tumors has not yet been established. This case suggests that TC therapy is effective not only as a neoadjuvant chemotherapy but also for cervical neuroendocrine tumors.
