Advanced small cell carcinoma of the uterine cervix treated by neoadjuvant chemotherapy with irinotecan and cisplatin followed by radical surgery

Abstract

Small cell carcinoma of the uterine cervix is a rare form of cervical cancer characterized by extreme aggressiveness and poor prognosis because of its rapid growth, frequent distant metastases, and resistance to conventional treatment modalities. We report here a case of advanced-stage small cell carcinoma of the uterine cervix treated by neoadjuvant chemotherapy, followed by radical surgery, resulting in locoregional disease control. A 39-year-old Japanese woman was diagnosed as having stage IIIb small cell carcinoma of the uterine cervix. She was treated by neoadjuvant chemotherapy with irinotecan/cisplatin, followed by extended radical hysterectomy with pelvic and paraaortic lymphadenectomy. The patient was further treated by adjuvant chemotherapy with irinotecan/cisplatin. Intrapelvic recurrence has not been detected throughout the postoperative course. However, the patient died with distant metastases of the disease, 27 months following the initial treatment. It has been suggested that neoadjuvant chemotherapy therapy followed by radical surgery is a treatment option for advanced-stage small cell carcinoma of the uterine cervix for the locoregional disease control. Further studies are necessary to obtain information regarding multimodal treatment including sequence, duration, frequency, and type of effective chemotherapy agents to be used in the treatment of small cell carcinoma of the uterine cervix.

Keywords: multimodal therapy.; neoadjuvant chemotherapy; small cell carcinoma; uterine cervical cancer.

Figure 1

Magnetic resonance imaging findings at initial diagnosis (A) and after 2 courses of neoadjuvant chemotherapy (B). (A) Magnetic resonance imaging at initial diagnosis revealed an enlarged uterine cervix (64×58 mm). (B) After 2 courses of neoadjuvant chemotherapy, a significant decrease in tumor size was achieved.

Figure 2

Immunohistological findings of the biopsied specimen. A, H&E; B, MNF116; C, chromogranin A; D, TTF-1 (original magnification ×400). The tumor showed typical features of small cell carcinoma. The tumor was densely cellular and showed trabecular nesting or a sheet-like pattern. The nuclei of the tumor cells were hyperchromatic. The cells had scant cytoplasm, round nuclei, an absence of nucleoli, and finely dispersed chromatin closely resembling the cells of oat cell carcinoma of the lung. Nuclear molding, single cell necrosis, and high mitotic activity were seen in all tumors. No areas of glandular or squamous differentiation were identified. Immunostaining revealed that the tumor cells were positive for MNF116 and chromogranin A and negative for TTF-1.