Synchronous cervical small-cell neuroendocrine carcinoma and cervical adenocarcinoma: a case report

Full text: Case presentation: A 36-year-old woman, black, smoker, presented with a history of pain in the right iliac fossa for the last 6 months. A transvaginal ultrasound showed a 3.5 cm heterogeneous cyst in the right ovary, referred to a tertiary hospital for investigation. On physical examination, a polypoid, friable and bleeding lesion was found on the posterior lip of the cervix. Patient reported normal uterine cervix cytopathology in the previous year. The lesion was biopsied, and pathology examination was compatible with endocervical villoglandular papillary adenocarcinoma, IB1 FIGO clinical stage. She underwent Querleu C1 radical hysterectomy, with bilateral salpingectomy, bilateral pelvic lymphadenectomy and biopsy of the capsule of right ovary cyst. The right ureter was injured during the procedure, and the psoas Hitch technique was also performed for urinary reconstruction. Pathology examination evidenced two distinct lesions: well-differentiated villoglandular adenocarcinoma of the posterior lip of the uterine cervix; and moderately differentiated endocervical adenocarcinoma of the anterior lip, presenting a mesonephric or neuroendocrine component. The immunohistochemical evaluation of the anterior lip tumor was compatible with small cell neuroendocrine carcinoma. Vascular invasion was present, limits were free and lymph nodes were negative. Biopsy of the right ovary confirmed a follicular cyst. Adjuvant treatment with chemotherapy (EP x 4) followed by radiotherapy was offered, but was suspended before the second cycle of chemotherapy by the patient, due to personal reasons. Follow-up consultation 8 months after surgery without abnormalities in the physical examination. Discussion: Cervical adenocarcinoma accounts for approximately 25% of all cervical cancers, while cervical neuroendocrine tumor accounts for around 1 to 1.5% of all cases. In the literature, there are rare case reports of synchronous uterine cervix adenocarcinoma and neuroendocrine tumor. Neuroendocrine tumor has a worse prognosis and a high risk of recurrence, being adjuvant treatment with chemoradiation usually indicated. Unfortunately our patient withdrew with the treatment. Until the present, no tumor relapse was reported. Final comments: There is still a lack of information on best treatment options for rare cancers. Case reports can contribute to enhancing decisions based on literature review. (author)