Small cell carcinoma of the uterine cervix. Cytologic findings in 13 cases

Department of Pathology, Prince George Regional Hospital and the University of British Columbia, Vancouver, Canada.
Cancer (Impact Factor: 4.89). 11/1998; 84(5):281-8. DOI: 10.1002/(SICI)1097-0142(19981025)84:53.0.CO;2-W
Source: PubMed


There are few reports on the cytologic features of small cell carcinoma (SMCC) of the uterine cervix.
The clinical records, histopathology, and available cervical smears from all cases of SMCC of the uterine cervix in the files of the British Columbia Cancer Agency between 1985 and 1997 were reviewed.
Cervical smears were available from 11 of 13 identified cases. Six cases had a pretreatment smear containing numerous definitely malignant cells. In the seven cases with reported negative smears, review of the most recent smears detected a missed high grade squamous intraepithelial lesion in one case and rare suspicious epithelial cells in a second case. These two cases were considered to be false-negative smears on review. None of the six malignant smears were diagnosed as SMCC on cervical smears. These smears were reported as malignant epithelial cells, not otherwise specified in three cases and misclassified as adenocarcinoma in three cases. These malignant smears contained cells dispersed as single cells or arranged as loosely cohesive sheets or gland-like aggregates. Tumor cells, ranging from small to large, had extremely pleomorphic, angulated nuclei that were hyperchromatic and showed nuclear molding and smearing. Mitotic figures were common and karyorrhectic debris was identified in all cases.
The routine cervical smear is a relatively insensitive and nonspecific method of detecting SMCC. The specific diagnosis of SMCC on cervical smears is difficult. SMCC can mimic inflammatory cells, follicular cervicitis, endometrial cells, endocervical adenocarcinoma, squamous cell carcinoma of small cell type, non-Hodgkin's lymphoma, and other unusual malignant neoplasms. The suspicion of SMCC on a cervical smear should prompt an urgent biopsy to establish the diagnosis and initiate prompt treatment.

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    • "In fact, all these patients who were alive without evidence of disease at the time of last follow up were diagnosed at an early stage with lesions <2 cm. Similarly, Sheets et al. showed that patients with tumors <2 cm had longer progression-free survival than patients with >2 cm lesions [16]. With more patients, FIGO stage and tumor size were confirmed important in this rare cervical malignancy in our study and may ultimately prove to be an important independent prognostic predictor for survival. "
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    ABSTRACT: Small cell carcinoma of the cervix (SCCC) is a very rare tumor. Due to its rarity and the long time period, there is a paucity of information pertaining to prognostic factors associated with survival. The objective of this study was to determine whether clinicopathologic finings or immunohistochemical presence of molecular markers predictive of clinical outcome in patients with SCCC. We retrospectively reviewed a total of 293 patients with SCCC (47 patients from Cancer Center of Sun Yat-sen University in china, 71 patients from case report of china journal, 175 patients from case report in PubMed database). Of those 293 patients with SCCC, the median survival time is 23 months. The 3-year overall survival rates (OS) and 3-year disease-free survival rates (DFS) for all patients were 34.5% and 31.1%, respectively. Univariate and multivariate analysis showed that FIGO stage (IIb-IV VS I-IIa, Hazard Ratio (HR) = 3.08, 95% confidence interval (CI) of ratio = [2.05, 4.63], P<0.001), tumor mass size (≥ 4 cm VS <4 cm, HR = 2.37, 95% CI = [1.28, 4.36], P = 0.006) and chromogranin A (CgA) (Positive VS Negative, HR = 1.81, 95% CI = [1.12, 2.91], P = 0.015) were predictive of poor prognosis. CgA stained positive was found to be highly predictive of death in early-stage (FIGO I-IIa) patient specifically. Patients with SCCC have poor prognosis. FIGO stage, tumor mass size and CgA stained positive may act as a surrogate for factors prognostic of survival. CgA may serve as a useful marker in prognostic evaluation for early-stage patients with SCCC.
    PLoS ONE 04/2012; 7(4):e33674. DOI:10.1371/journal.pone.0033674 · 3.23 Impact Factor
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    • "According to Kim et al. [9], the diagnostic accuracy of cytologic smears in diagnosing SMCC is low (approximately 38.5%). In addition, Wang et al. [10] reported that only 46% of the patients diagnosed with SMCC were diagnosed as having abnormal or malignant growths in cytologic smears, and Zhou et al. [11] reported that only 14% were diagnosed with abnormal or malignant growths. There was no patient diagnosed with SMCC in the cytology smears in both studies. "
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    ABSTRACT: Small cell carcinoma of the uterine cervix (SMCC) is extremely rare, and an aggressive disease that proliferates rapidly. It was often reported that the diagnostic accuracy of cytologic smears in diagnosing SMCC was low. This is a report of the Severance Hospital experience with the patients suffering from SMCC. Twenty-seven patients with small cell carcinoma of the uterine cervix were diagnosed and treated at the Severance Hospital from November 1991 to January 2010. The data were analyzed retrospectively, based on the available charts and pathology reports. Various fields, such as chief complaints and symptoms present at first clinic visit, age, International Federation of Obstetrics and Gynecology (FIGO) clinical stage, treatment modality, the 5-year overall survival rate, and recurrence rate were investigated. Among the 27 patients diagnosed with small cell carcinoma of the uterine cervix, 18 of them (66.7%) presented with symptoms, including vaginal bleeding, at the first clinic visit, and the remaining 9 patients (33.3%) showed abnormal Pap smear screening in the process of their routine health check-up. The median age of the patients was 54 years (range, 24 to 77 years). FIGO stage IIB was the most common stage (11 of 27 patients). The 5-year overall survival rate of 21 patients, who could be followed up, was 57.2%. Six patients showed recurrence after remission, and the mean disease free interval of them was 9.2 months (range, 6 to 11 months). Abnormal Pap smear screening results of 9 patients was investigated, and the diagnostic accuracy of the cytologic findings was 22.2%. Our study was consistent with the concept that Pap smear screening might not be helpful in early diagnosis of SMCC considering its low diagnostic accuracy. Further large-scale multicenter prospective studies are definitely needed in order to produce abundant information about optimal therapy and diagnosis.
    Journal of Gynecologic Oncology 03/2011; 22(1):39-43. DOI:10.3802/jgo.2011.22.1.39 · 2.49 Impact Factor
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    ABSTRACT: Large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive cervical neoplasm. Few cytologic or colposcopic findings of LCNEC have been reported. A 37-year-old woman, gravida 6, para 4, presented with vaginal bleeding for 3 months. The cervical smears showed cells dispersed as single cells or arranged as loosely cohesive sheets or glandlike aggregate and the nuclear size was almost 3-5 times larger than that of small lymphocytes. The cytologic, pathologic and immunohistochemical examinations suggested LCNEC. The patient underwent a radical hysterectomy and then received radiation and systemic chemotherapy. Cytologic and colposcopic findings for LCNEC of the uterine cervix are reported. Patients with LCNEC have poor prognoses. Early diagnosis of the tumor is important.
    Acta cytologica 11/2009; 54(5 Suppl):977-80. · 1.56 Impact Factor
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