Prenatal diagnosis and management of high-grade cervical neuroendocrine carcinoma: A case report

Abstract

High-grade neuroendocrine carcinoma of the cervix is a rare and aggressive malignancy, accounting for less than 2 % of all cervical cancers. Its occurrence during pregnancy is exceptional, with only 21 cases reported in the literature to date. This report presents the case of a 25-year-old primigravida diagnosed at 29.5 weeks of gestation with a high-grade small cell neuroendocrine carcinoma of the cervix, confirmed by histopathology and immunohistochemistry. The patient was initially managed conservatively, but tumor progression prompted delivery by cesarean section at 31 weeks, followed by immediate modified radical hysterectomy, bilateral pelvic lymphadenectomy, and partial omentectomy. Adjuvant chemotherapy with cisplatin and etoposide was administered. Pathological evaluation confirmed the diagnosis, with no lymph node or omental metastases. A comprehensive review of the literature identified 21 similar cases, highlighting the lack of standardized treatment protocols for this population. Multidisciplinary coordination was essential for balancing maternal oncologic priorities with fetal outcomes. This case contributes to the limited data on neuroendocrine cervical carcinoma in pregnancy and reinforces the importance of individualized, team-based management.

Keywords: Cervical cancer; Neuroendocrine carcinoma; Pregnancy; Radical hysterectomy; Small cell carcinoma.

Fig. 1

Magnetic resonance image of the abdomen and pelvis at 24 weeks of gestation. A single fetus in breech presentation is observed. There is no evidence of cervical lesions or pelvic lymphadenopathy.

Fig. 2

Surgical specimen of modified radical hysterectomy with bilateral salpingectomy performed immediately after cesarean section at 31 weeks of gestation. A: anterior view of the uterus; B: Anterior view of the uterus. Note the gross tumor distortion at the cervical level. C: Close-up of the cervical tumor from inferior aspect.

Fig. 3

Hematoxylin and eosin (H&E) stains and immunohistochemical panels of a high-grade small cell neuroendocrine carcinoma of the cervix. Surgical specimen of modified radical hysterectomy A: H&E 40× Large, hyperchromatic cells with low mitotic activity. B: H&E 40 x Solid and pseudoglandular nests. C: Ki-67 showing 80 % proliferation index. D: Focal expression of p16. E: Diffuse p16 expression. F: Positive chromogranin A expression. G: Positive CK7 expression.