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Won, Yi, Lee, Lee, Choi, and Kwak: MRI Findings of Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: A Case Report
Uroradiology

Journal of the Korean Society of Radiology 2015; 73(4): 274-278.

Published online: 25 September 2015

DOI: https://doi.org/10.3348/jksr.2015.73.4.274

MRI Findings of Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: A Case Report

Yousun Won, MD1, Boem Ha Yi, MD1, Hae Kyung Lee, MD1, Min Hee Lee, MD1, Seo-Youn Choi, MD1, Jeong Ja Kwak, MD2

1Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea.

2Department of Pathology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea.

Corresponding author: Boem Ha Yi, MD. Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea. Tel. 82-32-621-5851, Fax. 82-32-621-5874, rad1995@schmc.ac.kr

Received 6 April 2015       Revised 25 June 2015       Accepted 13 July 2015

Copyright © 2015 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Small cell neuroendocrine carcinoma of the uterine cervix is a rare primary neoplasm, accounting for less than 5% of all uterine cervical cancers. The tumor is known to have an aggressive behavior and poor prognosis. In this article, we present the MRI findings of 5 cases of pathologically-proven small cell neuroendocrine carcinoma of the uterine cervix, including diffusion-weighted images.

Keywords: Cervix Uteri, Carcinoma Neuroendocrine, Magnetic Resonance Imaging, Diffusion Magnetic Resonance Imaging

Figures and Tables

Fig. 1

MR images (A-C), gross specimen (D), and microscopic features (E, F) of small cell neuroendocine carcinoma in a 37-year-old female (patient 5).

A. The T2-weighted sagittal image shows a 4.6 cm-sized well-marginated high signal intensity mass (arrow) on the exocervix.
B, C. The uterine cervical mass shows diffusion restriction on diffusion-weighted images (b value = 1000 sec/mm2) and the apparent diffusion coefficient value was measured to be 5.24 × 10-4 mm2/sec.
D. The gross specimen shows a 4 × 3.5 cm-sized gray-brown colored mass.
E. Microscopic findings with hematoxylin and eosin stain (× 100) include a hypercellular tumor with hyperchromatic nuclei. The tumor cells have ovoid to angulated nuclei with moulding and scanty cytoplasm. Abundant apoptotic activities and mitoses are present.
F. An immunohistochemical stain of synaptophysin (× 100) shows diffuse strong positivity in tumor cells.
jksr-73-274-g001
Table 1

Clinical and Image Findings of 5 Patients with Small Cell Neuroendocrine Carcinoma in Uterine Cervix

jksr-73-274-i001
Patient 1 Patient 2 Patient 3 Patient 4 Patient 5
Clinical findings
 Age 50 60 47 44 37
 Chief complaint Leukorrhea Vaginal spotting Vaginal spotting Asymptomatic Leukorrhea
MR findings
 Size* 3.7 cm 4.3 cm 5.0 cm 1.2 cm 4.6 cm
 T1WI/T2WI High/high Iso/high Iso/high Iso/high Iso/high
 DWI Restricted Not conducted Restricted Not conducted Restricted
 ADC 9.53 × 10-4 Not conducted 6.52 × 10-4 Not conducted 5.24 × 10-4
 Enhancement Not conducted Heterogeneous Heterogeneous Homogeneous Not conducted
 Exo/endocervix Exocervix Exocervix Exocervix Endocervix Exocervix

*Longest diameter of tumor mass.

ADC = apparent diffusion coefficient, DWI = diffusion-weighted imaging, T1WI = T1-weighted image, T2WI = T2-weighted image

Table 2

Histologic Findings of 5 Patients with Small Cell Neuroendocrine Carcinoma in Uterine Cervix

jksr-73-274-i002
Patient 1 Patient 2 Patient 3 Patient 4 Patient 5
HPV HPV 16 (+) HPV 18 (+) (-) HPV 18 (+) HPV 18 (+)
LN metastasis Negative Negative Negative Negative Positive
Lymphovascular invasion (+) (+) (+) (-) (+)
p16 (+) (+) (+) (+) (+)
Neuroendocrine marker
 CG-A (-) (-) (+) (+) (+)
 Synaptophysin (-) (+) (+) (+) (+)
 CD56 (+) (+) (+) (+) (+)

CG-A = chromogranin-A, HPV = human papilloma virus, LN = lymph node

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