Small Cell Carcinoma of the Uterine Cervix in a Pregnant Patient Diagnosed with Liquid Based Cytology and Cell Block Immunocytochemistry

Abstract

Definitive cytomorphologic diagnosis of small cell carcinoma of the uterine cervix is possible but can be challenging in routine cervicovaginal cancer screening specimens. Several small series of reported cases of cervical small cell carcinoma have shown this uncommon malignancy to represent fewer than 2% of all invasive cervical cancers. This tumor type is associated with poor prognosis and rapid disease progression and can develop to an advanced stage in the interval between screening visits. Only rare case reports of small cell carcinoma arising in gravid cervices are known. In the current case a 29-year-old, gravida 6, para 2, pregnant (10-week gestation) female presented with postcoital bleeding. A definitive diagnosis of small cell carcinoma of the cervix was made possible by liquid based Pap testing with ancillary cell block preparation allowing for immunocytochemical characterization of the lesional cell population.

Liquid‐based cytology and immunocytochemistry in the evaluation of a vault lesion in a postmenopausal woman

“…Very occasionally, the exfoliated tumour cells from the cervix or, as in the index case, from the vault, may be identified on cervical smears. Few such cases have been documented in the literature 3–7 . The smears often show variable numbers of hyperchromatic crowded cell groups or singly scattered atypical cells.…”

Practical Approach to the Evaluation of Malignant Peritoneal Fluids in the Setting of Gynecologic Neoplasms

“…The tumor nuclei often show molding, finely granular or stippled chromatin, and smear artifact, similar to small cell carcinoma of the lung [169,170]. The background is mostly clean but may show tumor diathesis and apoptotic debris [169]. Immunocytochemistry for neuroendocrine markers, such as synaptophysin, chromogranin, NSE, and CD56, is positive in most cases.…”

“…22). The tumor nuclei often show molding, finely granular or stippled chromatin, and smear artifact, similar to small cell carcinoma of the lung [169,170]. The background is mostly clean but may show tumor diathesis and apoptotic debris [169].…”

“…Small cell carcinoma of the cervix can exfoliate tumor cells into the peritoneal fluid [169]. The tumor cells are seen as single isolated cells, sheets, or three-dimensional clusters of small hyperchromatic cells.…”

“…Immunocytochemistry for neuroendocrine markers, such as synaptophysin, chromogranin, NSE, and CD56, is positive in most cases. Although not required to make the diagnosis, ancillary studies may be necessary to distinguish small cell carcinoma of the cervix from other tumors of similar morphology, including poorly differentiated nonkeratinizing squamous cell carcinoma, embryonal rhabdomyosarco-ma, endometrial stromal sarcoma, and lymphoma [169]. Of note, HPV in situ hybridization is positive in small cell carcinoma of the cervix as these cases arise in the setting of high-risk HPV infection (mostly HPV type 18).…”