Complexities in differential diagnosis of poorly differentiated large cell neuroendocrine carcinoma of the cervix: a case report
https://doi.org/10.21294/1814-4861-2025-24-4-178-185
Abstract
Neuroendocrine tumors (NETs) of the female reproductive system, including the cervix, are considered to be extremely rare localizations. the majority (about 80 %) of these cervical NETs are small-cell neuroendocrine carcinomas (SCNECs), which are highly aggressive and have a poor prognosis. Many SCNECs are not recognized leading to a missed diagnosis. Diagnosis relies on identifying neuroendocrine differentiation through immunohistochemical (IHC) examinations, but sometimes this step is omitted.
Case presentation. We herein report a case of a low-differentiated large-cell neuroendocrine carcinoma of the cervix in a 40-yearold woman. Verification of the diagnosis was challenging, that required the use of an extended diagnostic complex to identify the optimal management strategy. After surgery the patient received a total of 4 lines of chemotherapy and underwent IHC testings. However, despite all efforts, the patient’s condition worsened significantly, leading to the death 2 years and 1 month after her initial visit.
Conclusion. Vague symptoms, aggressive progression, diagnostic difficulty, and limited treatments indicate the need to create specialized centers for the treatment of NETs of any tumor grade and location.
About the Authors
E. V. Markarova
M.F. Vladimirsky Moscow Research Clinical Institute
Russian Federation
Russian Federation
Ekaterina V. Markarova, MD, PhD, Associate Professor, Department of Oncology and Thoracic Surgery
61/2, Shchepkina st., Moscow, 129110
L. E. Gurevich
M.F. Vladimirsky Moscow Research Clinical Institute
Russian Federation
Russian Federation
Larisa E. Gurevich, DSc, Professor, Leading Researcher, Morphological Department, Department of Oncology
61/2, Shchepkina st., Moscow, 129110
E. V. Bondarenko
M.F. Vladimirsky Moscow Research Clinical Institute ; I.I. Dedov Endocrinology Research Center, Ministry of Health of Russia
Russian Federation
Russian Federation
Ekaterina V. Bondarenko, MD, PhD, Head of the Biobanking Group; Associate Professor, Department of Pathological Anatomy and Forensic Medicine
61/2, Shchepkina st., Moscow, 129110
11, D. Ulyanova st., Moscow, 117292
V. E. Shikinа
M.F. Vladimirsky Moscow Research Clinical Institute
Russian Federation
Russian Federation
Valentina E. Shikinа, MD, PhD, Deputy Director for Oncology
61/2, Shchepkina st., Moscow, 129110
L. M. Kogonia
M.F. Vladimirsky Moscow Research Clinical Institute
Russian Federation
Russian Federation
Lali M. Kogonia, MD, DSc, Professor, Department of Oncology and Thoracic Surgery
61/2, Shchepkina st., Moscow, 129110
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Supplementary files
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1. Fig. 1. Microphoto. Large-cell neuroendocrine carcinoma of the cervix. A. The tumor is formed from trabecular and papillary structures, ×250. B. At higher magnification: mitotic figures and apoptotic bodies are visible, ×400. Positive reaction of tumor cells with general markers of neuroendocrine differentiation: with synaptophysin (C), chromogranin A (D) and INSM-1 (E), ×125, ×250 and ×250, respectively. E. High proliferative activity of tumor cells, Ki67 index – 73.5 %, ×250. G. Intense cytoplasmic expression of p16 in tumor cells, ×250. H. Expression of progesterone receptors in the cervical stroma, but not in tumor cells, ×250. I. Intense expression of cytokeratin 7 in tumor cells, ×125. K. Metastasis of cervical NEC to the muscle, ×40. A, B, K. – hematoxylin and eosin staining. C–I – IHC reaction. Note: created by the authors | |
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Markarova E.V., Gurevich L.E., Bondarenko E.V., Shikinа V.E., Kogonia L.M. Complexities in differential diagnosis of poorly differentiated large cell neuroendocrine carcinoma of the cervix: a case report. Siberian journal of oncology. 2025;24(4):178-185. (In Russ.) https://doi.org/10.21294/1814-4861-2025-24-4-178-185
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