of Week Home
24 September 2014 - Case of the Week #327
All cases are archived on our website. To view them sorted by number, diagnosis or category, visit our Home Page and click on the Case of the Week button on the left hand side. To subscribe or unsubscribe to the Case of the Week or our other email lists, click here.
Thanks to Dr. Jamie Shutter, Women's Care Florida Laboratory (USA), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
(1) PathologyOutlines.com is the major sponsor of The Detroit College Promise (DCP), a tax-exempt nonprofit which provides scholarships for Detroit Public School students. DCP is part of an online fundraising challenge, with the potential to receive an additional $10,000 to $50,000 for raising the most funds. If you value PathologyOutlines.com, and feel charitable, please consider donating to this campaign. If you donate at least $25, you will automatically be signed up to win one of four $500 Moosejaw gift cards, and can also feel good about helping make the world a better place. Please click here to donate.
(2) We broke another website traffic record with 28,022 visits on September 18, 2014. We keep improving so you will keep coming back. Thank you!
(3) Do you use Amazon.com? You can support our free website just by making an Amazon purchase IF you enter Amazon through a banner or link on our website, or by clicking here. Amazon uses third parties to market their website, and pays out of the money they receive - it doesn't cost you anything extra. Thanks!
(4) We enjoy seeing and talking with the pathology community at the conferences we attend, and CAP '14 is no different. Thanks again to everyone who stopped by. Pictures are available on our Blog and Facebook page.
(5) Visit our Updates page to see what topics have been revised based on reviews or new images.
Case of the Week #327
A 27 year old woman had a 6 cm cervical mass, which was biopsied. The outside diagnosis was poorly differentiated carcinoma, suggestive of adenocarcinoma.
What is your diagnosis?
The biopsy shows a poorly differentiated carcinoma with neuroendocrine histology, including a vague ribbon pattern and salt and pepper chromatin. Immunohistochemistry also confirmed the tumor's neuroendocrine features:
An additional biopsy was obtained, showing similar histology but also >10 mitotic figures per 10 HPF. Additional immunostain results were focal p63 staining, and negative staining for HMB45, LCA / CD45, CK20, NSE, polyclonal CEA, vimentin and p53. The morphologic features and positive (albeit not strong) neuroendocrine immunostains are most consistent with a poorly differentiated neuroendocrine carcinoma of endocervical origin.
Cervical neuroendocrine carcinomas, whether small cell or large cell type, are aggressive tumors with rapid metastases. They are frequently treated with a combination of chemotherapy and radiation, so the initial biopsy may be the only time to get diagnostic tissue.
The differential diagnosis includes:
• metastatic carcinoma from the lung or another primary site
• carcinoid tumor
• basaloid squamous cell carcinoma (strong p63 staining, no neuroendocrine features) and small cell squamous cell carcinoma
Nat Pernick, M.D., President
and Shivani Thakore, Associate Medical Editor
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: [email protected]