Small cell neuroendocrine tumour of the endometrium and the importance of pathologic diagnosis

Abstract

Small cell carcinoma of the endometrium is a very rare entity. They are very aggressive tumours, with a poor prognosis. They represent a clinical challenge because of a lack of a standardised treatment. We see here a case of a 67-year-old woman with a history of a lobular breast carcinoma, diagnosed in 2002. After presenting with postmenopausal vaginal bleeding in October 2014, she underwent a hysteroscopy-guided biopsy which revealed a metastasis of breast carcinoma. A hysterectomy and bilateral oophorectomy was performed because of uncontrolled uterine bleeding. The pathologic diagnosis was small cell carcinoma (SCC) of the endometrium. A surgical complete cytoreduction was achieved after the case being presented in a multidisciplinary tumour board. Pathologic results revealed metastasis from peritoneal implants of SCC on the endometrium, and metastasis in pelvic and para-aortic lymph nodes from serous carcinoma of the endometrium. A total of four cycles of adjuvant chemotherapy based on cisplatin (80mg/m² day one) and etoposide (100mg/m² day one, two, three) every 21 days was given. The patient experienced persistent disease and died 17 months after the diagnosis. SCC of the endometrium is a very rare and aggressive disease that requires an individualised multidisciplinary management.

Keywords: endometrial cancer; endometrium; pathology diagnosis; small neuroendocrine tumour.

Figure 1.. A) Macroscopic tumour: an 8 cm tumour with a myometrial infiltration of more than 50%, reaching the uterine serosa B) H-E 20x: Solid tumoural nests are observed, consisting of small cells with limited cytoplasm.

Figure 2.. A) Neoplastic nest, consisting of small cells with cytoplasmic positivity to chromogranin A. B) : Tumour cells with cytoplasmic positivity to synaptophysin.

Figure 3.. A) Peritoneal implants, consisting of small cells and IHQ pattern very similar to neuroendocrine primary tumour. B) Lymph nodes metastasis from serous carcinoma with synaptophysin (-) and chromogranin A (-).