Large Cell Neuroendocrine Carcinoma of the Uterine Cervix

A 53 y/o multiparous woman, presented with postcoital vaginal bleeding for one month. On pelvic examination, a neogrowth lesion measured as 2x2 cm over cervix, radical hysterectomy with bilateral pelvic lymph node dissection and paraaortic lymph node sampling was performed thereafter. The final pathological report showed large cell neuroendocrine carcinoma (LCNEC) without lymph node involvement. Pathological findings revealed the tumor cells had abundant granular cytoplasm with mediunto-large vesicular nuclei and prominent nucleoli with diffuse adenocarcinomatous pattern and immunoreactive for synaptophysin stain. Furthermore, vascular invasion was prominent and numerous mitoses (>10 MF/ 10HPF) noted in the specimen. Cervical neuroendocrine tumors of non-small cell type are uncommon but distinct from squamous cell carcinoma and adenocarcinoma. LCNECs of the cervix, however, are probably still underrecognized as a specific entity, and some tumors are likely misclassified as poorly differentiated squamous cell carcinoma, adenocarcinoma, or carcinoid tumor. Vascular invasion in LCNECs was much more common than in other types of cervical carcinomas. The optimal therapy of cervical LCNECs remains to be determined because few studies have contained sufficient data to allow for definite therapeutic recommendations. Recently neoadjuvant or postoperative chemotherapy has been used in an attempt to improve survival of cervical neuroendocrine carcinoma. We offered this case post-operative adjuvant systemic chemotherapy with regimen of cisplatin, vp-16 and cyclophosphamide for 6 cycles. Currently, no evidence of local recurrence occurred.