Neuroendocrine carcinoma of uterine cervix findings shown by MRI for staging and survival analysis - Japan multicenter study

Abstract

Objectives: To investigate neuroendocrine carcinoma (NEC) of the uterine cervix cases for MRI features and staging, as well as pathological correlations and survival. Results: FIGO was I in 42, II in 14, III in 1, and IV in 5 patients. T2-weighted MRI showed homogeneous slightly high signal intensity and obvious restricted diffusion (ADC map, low intensity; DWI, high intensity) throughout the tumor in most cases, and mild enhancement in two-thirds. In 50 patients who underwent a radical hysterectomy and lymphadenectomy without neoadjuvant chemotherapy (NAC), intrapelvic T staging by MRI overall accuracy was 88.0% with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for metastatic pelvic lymph node detection was 38.5%, 100%, and 83.3%, respectively. During a mean follow-up period of 45.6 months (range 4.3-151.0 months), 28 patients (45.2%) experienced recurrence and 24 (38.7%) died. Three-year progression-free and overall survival rates for FIGO I, II, III, and IV were 64.3% and 80.9%, 50% and 64.3%, 0% and 0%, and 0% and 0%, respectively. Materials and Methods: Sixty-two patients with histologically surgery-proven uterine cervical NEC were enrolled. Twelve received NAC. Clinical data, pathological findings, and pretreatment pelvic MRI findings were retrospectively reviewed. Thirtytwo tumors were pure NEC and 30 mixed with other histotypes. The NECs were small cell type (41), large cell type (18), or a mixture of both (3). Conclusions: Homogeneous lesion texture with obvious restricted diffusion throughout the tumor are features suggestive of cervical NEC. Our findings show that MRI is reliable for T staging of cervical NEC.

Neuroendocrine Neoplasms of the Gynecologic Tract

“…Imaging is critical for tumor staging, while histology is essential for diagnosis but not for assessing the extent of the tumor spread [ 72 ]. Hence, imaging modalities including computed tomography (CT), magnetic resonance imaging (MRI), and 18 F fluoro-deoxy-glucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) should be considered to evaluate and stage the NEN.…”

Classifying Pulmonary and Urinary High-grade Neuroendocrine Carcinoma by CK7 Immunohistochemistry

“…Although magnetic resonance imaging revealed abnormally high signal on diffusion-weighted imaging and low apparent diffusion coefficients in NEC, these findings do not differentiate between SmCC and LCNEC. [39][40][41][42] Such nonspecific identification was also demonstrated on imaging studies such as positron emission tomography-CT 38 and conventional radiograph of the chest and CT scan. 31 In some studies, molecular markers were used for further classification of HGNEC, which was especially important for the chemotherapy and neoadjuvant chemotherapy of advanced HGNEC patients.…”

“…Furthermore, SmCC is usually central, often overshadowed by the mediastinal involvement, while LCNEC typically is a peripheral parenchymal mass, without or with (less common) nodal enlargement. Although magnetic resonance imaging revealed abnormally high signal on diffusion-weighted imaging and low apparent diffusion coefficients in NEC, these findings do not differentiate between SmCC and LCNEC 39–42. Such nonspecific identification was also demonstrated on imaging studies such as positron emission tomography-CT38 and conventional radiograph of the chest and CT scan 31…”

Small Cell Neuroendocrine Carcinoma of Cervix: A Rare Case Report

“…Also MRI will reliably help to 'T'stage these cancers and is thus recommended in all suspected cervix malignancies. 8 Histomorphological, they have the same appearance as small cell carcinoma of lungs and elsewhere. Neoplastic small cells are seen in solid sheets, nests and clusters with sometimes pseudo rosette formation.…”