Case Of The Month -November 2005

Small Cell Undifferentiated Carcinoma of the Cervix

Clinical Details

45 year old female presented for routine smear. History of CIN 3 in 1993. Annual smears since, all normal.

Smear in 2005 reported as ASCUS possible high grade lesion. Referred to colposcopy. Abnormal appearing cervix noted. Biopsy diagnosed as Neuroendocine carcinoma.

Cytology

The smear shows small round to oval cells singly and in aggregates and syncytial type tissue fragments without achitecture. The cells show scant to inconspicuous cytolplasm. Chromatin is coarsely granular, nucleoli are inconspicuous and nuclear molding is evident. Previous smears reviewed. All negative.

Histology

Sections show fibrous stroma infiltrated by tumour composed of islands and cords of small round to oval cells with hyperchomatic nuclei, scant cytoplasm with a very high N/C ratio. There is high mitotic activity and apoptotic bodies present. The immunoprofile shows positive reactivity to neuroendocrine markers.

Discussion

Neuroendocine carcinomas of the cervix are rare aggressive neoplasms associated with poor prognosis. They represent a heterogeneous group of tumors with a spectrum of morphologic features including classic small cell carcinoid like tumors with focal squamous or glandular differentiation.

References

• Kini SR. Colour Atlas of Differential Diagnosis in Exfoliative and Aspiration Cytology. Baltimore, Maryland: Williams and Wilkins, 1999:49-50.

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Thanks to Paul for submitting this case