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24 September 2014 - Case of the Week #327
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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: NatPernick@gmail.com