Small cell carcinoma of the uterine cervix: cytologic findings in 13 cases
ABSTRACT 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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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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ABSTRACT: The aim of this study was to analyze diagnostic criteria, response to chemotherapy, rate and site of relapse, and overall survival (OS) in neuroendocrine cervical carcinoma. Twenty patients were included. Stage was Ia(2) in 1 case, Ib(1) in 4, Ib(2) in 4, II in 5, IIIb in 2, IVa in 2, and IVb in 2. Patients with stage Ib(2) or greater received neoadjuvant chemotherapy (NCH). Eighteen patients were operated on. Immunohistochemistry was performed on the surgical specimens. Statistical analysis included the Kaplan-Meier method and the chi(2) and log-rank tests. The response to NCH was <50% in 2/13 cases (15.3%), >50% in 9/13 (69.4%), and complete in 2/13 (15.3%). Cytokeratin was positive in 17/18 cases, neuron-specific enolase in 15/18, chromogranin in 9/18, and synaptophysin in 8/18. Tumor was pure in 12 cases. Two cases had simultaneous ovarian carcinoma. Positive nodes were observed in 9/20 pts (45%). Tumors <4 cm had no recurrences. Pure tumors >4 cm had distant relapses (6/11). Mixed tumors >4 cm had 2/6 pelvic and 3/6 lung metastases. OS was 39%. When the initial tumor volume was <4 cm OS was 76%, and it was 18% for tumors >4 cm (P < 0.05). OS was 58% when the residual tumor after NCH was <2 cm and 21% when it was >2 cm (P < 0.05). When the tumor was pure OS was 54% and 19% when it was mixed (P < 0.05). OS was 72% among pts with negative nodes and 11% for those with positive nodes (P < 0.01). (1) Stage IV was frequent (20%); (2) Response to NCH was high; (3) The pattern of relapse differs for mixed tumors; (4) For tumors <4 cm outcome is similar to that of squamous carcinoma.Gynecologic Oncology 07/2001; 82(1):32-9. DOI:10.1006/gyno.2001.6201 · 3.69 Impact Factor
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ABSTRACT: The objective of this study was to determine whether clinicopathologic findings or the immunohistochemical presence of molecular markers are predictive of clinical outcome in patients with small cell carcinoma of the cervix (SCCC). A retrospective review of cases of carcinoma of the cervix was conducted to identify SCCC. From 1978 to 1999, 16 patients were identified at our institution with the diagnosis of SCCC. Microscopic sections of paraffin-embedded tissue specimens were evaluated for confirmation of diagnosis. Specimens were immunohistochemically stained with antibodies to three neuroendocrine markers: neuron-specific enolase, chromagranin (CGR), and synaptophysin. Specimens were also stained for protein expression of p53, erbB2, proliferating cell nuclear antigen, and c-myc. The relationship between molecular markers and clinical outcome was determined. All 16 cases met the histologic criteria for SCCC. Fourteen of 16 tumors (88%) stained positive for neuroendocrine differentiation. Eleven of 16 patients (69%) died from disease with a median survival of 19 months; there were 3 long-term survivors (greater than 5 years). CGR was positive in 8 (50%) specimens and was found to be highly predictive of death (P = 0.001). Complete loss of p53 protein was seen in 8 patients, 7 of whom died with a median survival of 20 months. Immunohistochemistry can be helpful in confirming difficult cases of SCCC. Further studies are necessary to define molecular markers that may be predictive of outcome in patients with SCCC.Gynecologic Oncology 12/2001; 83(2):216-20. DOI:10.1006/gyno.2001.6385 · 3.69 Impact Factor