Neuroendocrine Tumors of Cervix – Clinical, Morphologic, Immunophenotypic, and Electron Microscopic Features in Two Cases
Binara Assylbekova, Shereen Billah, Steven Kolodziej, Meenakshi Bhattacharjee. University of Texas Medical School at Houston, Houston, TX
Background: Neuroendocrine tumors of the uterine cervix are rare in the gynecologic tract. The most recent Surveillance, Epidemiology and End-Results data on neuroendocrine tumors of the uterine cervix reported incidence of 0.42 cases per 1,000,000 women. They are being increasingly recognized with the more routine use of immunostaining in the evaluation of histopathologic features suggesting neuroendocrine differentiation. They can be a pure lesion or occur in combination with adenocarcinoma or squamous cell carcinoma. Analogous to lung neuroendocrine tumors, cervical tumors are classified in four groups that are carcinoid, atypical carcinoid, large cell neuroendocrine tumors and small cell carcinoma. The former are grouped with the neuroendocrine tumors, whereas the latter are categorized as neuroendocrine carcinomas (NECs).
Design: We report the clinical and complete pathologic features in two such cases. The patients were 48 and 71 y and presented with vaginal bleeding. Both were multiparous females; both had history of hypertension and one was a smoker. Direct examination, and imaging studies revealed large cervical/lower uterine masses with obvious pelvic lymphadenopathy in one. The tumors ranged from 3.5 and 11.3 cm.
Results: Biopsies and hysterectomy specimens showed prominent neuroendocrine features by conventional morphology, with inconsistent immunostaining results; focal adenocarcinoma features were seen in one case. Transmission electron microscopy showed poorly differentiated cells with large nuclei with dispersed heterochromatin, prominent nucleoli, and occasional cytoplasmic dense-core granules. No cytoplasmic intermediate filaments were seen. Focally, luminal intercellular junctions were seen in the case with focal adenocarcinomatous features.
Conclusions: Recognition of NECs is important for appropriate therapy and management since these patients have worse clinical outcomes when compared with conventional cervical squamous or adenocarcinomas. Immunohistochemistry may be inconclusive in determining neuroendocrine differentiation, and should be supplemented with ultrastructural studies for confirmation and correct categorization of the carcinoma for appropriate management.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 314, Monday Morning