Cervix
Carcinoma
Small cell (neuroendocrine / undifferentiated) carcinoma

Author: Branko Perunovic, M.D. (see Authors page)

Revised: 15 May 2017, last major update May 2007

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Small cell carcinoma [title] cervix

Cite this page: Cervix - Small cell (neuroendocrine / undifferentiated) carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cervixsmallcell.html. Accessed October 17th, 2017.
Definition / general
  • Rare (2 - 5% of invasive cervical carcinomas); clinically aggressive with rapid metastases; frequently presents with parametrial invasion and pelvic lymph node metastases
  • Similar age as squamous cell carcinoma (mean 43 years, range 23 to 63 years)
  • Associated with HPV - 18 (Am J Surg Pathol 1991;15:28); occasionally associated with Cushing syndrome or symptoms of other peptide hormones
  • Coexisting SIL is rare; endocrine cell hyperplasia may be a precursor lesion
  • 5 year survival is 30 - 40%; relapse in 2/3 at median 8 months (Gynecol Oncol 2004;93:27), poor prognostic factors are smoking and high stage (Cancer 2003;97:568), focal glandular differentiation does not affect prognosis
  • Amphicrine carcinoma: small cell carcinoma combined with squamous cell carcinoma or adenocarcinoma
Case reports
Treatment
  • Radical hysterectomy with bilateral lymphadenectomy, radiation therapy and chemotherapy
Gross images
  • May be ulcerative and infiltrative
  • Often barrel shaped cervix
Microscopic (histologic) description
  • Loose aggregates of uniform small cells with indistinct cell borders, scant cytoplasm, hyperchromatic nuclei with fine granular chromatin, nuclear molding, indistinct nucleoli, extensive mitotic activity, single cell necrosis
  • May form sheets with small acini resembling rosettes
  • Necrosis common
  • Vascular invasion in 9%
  • Resembles counterpart in lung
  • Patterns include insular (solid nests / islands of cells with peripheral palisading and retraction of stroma), perivascular and thick trabeculae with serpiginous (wavy) growth
  • Variable amyloid deposition
  • May have minor (< 10%) component of glandular or squamous differentiation
  • Often no associated inflammation
Microscopic (histologic) images

Images hosted on PathOut server:

Sheets of small cells with scant cytoplasm and hyperchromatic nuclei


Case of the Week #327:

H&E


CK7

p16

Chromogranin

Synaptophysin


Images hosted on other servers:

H&E


Positive stains
Electron microscopy description
  • Cells are tightly packed with close apposition of cell membranes
  • Dense core secretory granules
Molecular / cytogenetics description
  • Frequent loss of heterozygosity at 3p and 11p
Differential diagnosis
Additional references