Small cell neuroendocrine carcinoma of the cervix: outcome and patterns of recurrence☆
Introduction
Small cell neuroendocrine carcinoma of the uterine cervix (SCNEC) is a rare malignancy, representing less than 5% of all cases of cervical cancer. It is characterized by frequent and early nodal and distant metastases, resulting in a relatively poor prognosis. Histologically, SCNEC is indistinguishable from small cell carcinoma in other sites. Characteristic features include small (less than two to three times the diameter of a small resting lymphocyte or 14–21 μm) cells with hyperchromatic nuclei and scant cytoplasm. Nucleoli are inconspicuous or absent. Frequent mitoses as well as necrosis are commonly identified. Small cell carcinoma is diagnosed on hematoxylin–eosin staining alone and is independent of the extent of neuroendocrine differentiation [1]. However, neuroendocrine markers are commonly used to assist in classification. Up to 80% of hematoxylin- and eosin-diagnosed small cell carcinomas also stain positive with neuroendocrine markers [2].
Most clinicians favor the use of chemotherapy to treat SCNEC because of the strong evidence supporting concurrent chemoradiation in other types of cervical cancer and high incidence of distant metastases in the SCNEC subgroup. However, the regimen, timing, and duration of chemotherapy remain controversial. Although patients with locoregionally advanced disease are usually treated with radiation therapy, the optimal locoregional treatment for women with early-stage cancers has not been determined. On the basis of similarities between SCNEC and small cell lung cancer, it has been suggested that prophylactic cranial irradiation may be indicated; however, its role has not been clearly defined [3].
We performed a retrospective review to learn more about patterns of relapse, treatment effectiveness, and overall survival in women with neuroendocrine marker-positive small cell carcinoma of the cervix.
Section snippets
Methods
A database of patients treated for carcinoma of the uterine cervix at The University of Texas M.D. Anderson Cancer Center was searched to identify patients whose tumors were described in the original pathology reports as “small cell” or “neuroendocrine” cervical carcinoma. Patients who had hematogenous distant metastases at diagnosis were excluded. Fifty-one patients met these criteria.
For this study, a gynecologic pathologist (M.D.) reexamined all the available biopsy and hysterectomy
Patient characteristics
The median patient age was 46 years (range, 26–78 years) (Table 1). Race was recorded as white in 14 patients, African American in 2, Hispanic in 3, and Asian in 2. Five patients reported a history of tobacco use. The mean hemoglobin concentration at diagnosis was 12 g/dl.
Fifteen patients had stage I disease, and six had stage II or III disease. None of the six patients treated with radical hysterectomy had evidence of lymph node involvement. However, 6 of the 15 patients treated with radiation
Discussion
For this study, we restricted our analysis to patients with neuroendocrine marker-positive small cell carcinoma. A key component of our review was that all pathologic material was rereviewed by one pathologist using modern classification methods and staining techniques. Our approach is important because confusion about definitions of disease has made it difficult to interpret the results of previous reports on small cell carcinomas of the cervix. Albores-Saavedra et al. [4] published the first
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Presented at the 44th annual meeting of the American Society of Therapeutic Radiation Oncology, October 7, 2002.