Small Cell Carcinoma of the Uterine Cervix: A Clinicophthologic, Ultrastructural, and Immunohistochemical Study of 4 Cases

Choi, Jae Seone; You, Byeong Dae; Nam, Sang Ryun; Sheo, Kwang Sun

Abstract

Small cell carcinoma of the cervix has been traditionally considered a rare subtype ofsquamous cell carcinoma characterized by a highly malignant behavior. However, it has becomeobvious that the majority of small cell carcinomas of the cervix expresses neuroendocrine,not squamous, differentiation. One case of intermediate cell neuroendocrine carinoma andthree cases of small cell undifferentiated carcinoma were reported. Patients ranged in age from37 to 50 (median, 44years) and presental as stages Ib(two patients), IIa(one patient), andIIb(one patient). One cases of intermediate cell neuroendocrine carinoma was combined with-endocervical adenocarcinoma and one case of small cell undifferentiated carcinoma was combinedwith adenocarcinoma in situ. All 4 tumors expressed one or more epithelial markers andneuroendocrine markers. Electron microscopically, neuroendocrine granules were observed inall 4 cases but large amount in intermediate cell neuroendocrine carinoma. A variety of treatmentregimens was employed. One patient with intermediate cell neuroendocrine carinoma isalive now for 60 months after starting of treatment. But two of three patients with small cellundifferentiated carcinoma died of disease (34, 45 months) and one of them is alive now for20 months. One patient had spinal metastasis and paraplegia which were treated twice withsurgery and irradiation on tumor bed and the other patient was comatose with multiple livermetastasis. Small cell undifferentiated carcinoma of the cervix was more aggressive thanintermediate cell neuroendocrine carcinoma of the cervix. We can differentiate small cellundifferentiated carcinoma of the cervix from intermediate cell neuroendocrine carcinoma of thecervix, pathologically, ultrastructurally and immunocytochemically.