cervical large cell neuroendocrine carcinoma

Cervical Large Cell Neuroendocrine Carcinoma (LCNEC): A Rare and Aggressive Form of Cervical Cancer

Cervical large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive subtype of cervical cancer, accounting for approximately 2-5% of all cervical cancer cases [6]. It is characterized by the presence of malignant cells with abundant cytoplasm, large nuclei, and neuroendocrine differentiation [12].

Histological Features

The histologic features of LCNEC include:

• Neuroendocrine morphology such as organoid nesting, palisading rosettes, and trabeculae
• High mitotic rate, often exceeding 10-15 mitoses per 10 high-power fields
• Presence of large cells with neuroendocrine differentiation [

Common Signs and Symptoms

Cervical large cell neuroendocrine carcinoma (LCNEC) often presents with symptoms similar to other cervical cancers, such as:

• Irregular vaginal bleeding: This is the most common symptom, which can occur at any time, including during or after sex, or even after menopause [3][4].
• Vaginal discharge: Some women may experience abnormal vaginal discharge, which can be a sign of the tumor's presence.
• Abnormal Pap smear results: Women with LCNEC may have an abnormal Pap smear result, leading to further investigation and diagnosis.

Other Possible Symptoms

While not as common, other symptoms that may occur in some cases include:

• Pelvic pain: Some women may experience pelvic pain or discomfort due to the tumor's growth.
• Abnormal menstrual bleeding: Women with LCNEC may experience irregular or heavy menstrual bleeding.

Important Notes

It is essential to note that these symptoms can also be present in other cervical cancer types, making it crucial for early detection and diagnosis. If you are experiencing any of these symptoms, consult a healthcare professional for proper evaluation and care.

References:

[1] Small cell and large cell cervical cancers are the most common type of neuroendocrine tumor in the cervix, but still accounts for less than 1% of all cervical cancers. [3] by B Yoseph · 2012 · Cited by 23 — Patients with LCNEC often present in the early stages with vaginal bleeding or are diagnosed during regular vaginal check-ups. [4] by AV Tangella · 2023 · Cited by 2 — NECC commonly presents with symptoms similar to other cervical cancers, such as irregular vaginal bleeding, postcoital bleeding, or ... [8] by X Zhang · 2023 · Cited by 1 — The clinical manifestations of NECC vary and are similar to those of other types of cervical carcinomas. These manifestations include vaginal bleeding, ...

Diagnostic Tests for Cervical Large Cell Neuroendocrine Carcinoma

Cervical large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive type of cancer that requires prompt diagnosis and treatment. The following diagnostic tests can help identify this condition:

• Liquid-based Pap smear: A liquid-based Pap smear can detect abnormal cells, including those associated with LCNEC [1]. However, many women with this disease may have normal Pap smears before the tumor is detected [4].
• Immunohistochemistry (IHC): IHC markers such as synaptophysin, chromogranin, and neuron-specific enolase can confirm the diagnosis of LCNEC [3]. These markers are usually used in combination to ensure accurate results.
• PET/CT scan: A PET/CT scan is often ordered to assess the extent of cancer spread, particularly to lymph nodes, liver, and lung [8].
• Biopsy: A biopsy may be performed to confirm the diagnosis of LCNEC. Neoadjuvant therapy may be considered in cases where LCNEC is diagnosed on a preoperative curettage or endometrial biopsy specimen [9].

Important Notes

• The sensitivity of IHC markers can vary, and some cases of small cell NECC may have negative expression of neuroendocrine markers [7].
• A PET/CT scan is essential to evaluate the extent of cancer spread.
• Biopsy results should be interpreted in conjunction with clinical findings.

References:

[1] Yoseph et al. (2012) - Liquid-based Pap specimen showing clusters of tumor cells.

[3] Tangella et al. (2023) - The diagnosis of NECC is confirmed by immunohistochemistry.

[4] Zhang et al. (2023) - Small and large cell cervical tumors can be detected with a Pap smear.

[7] Tempfer et al. (2018) - SYN and CD56 are the most sensitive markers.

[8] (2016) - Because of the tendency for small- and large-cell carcinomas of the cervix to spread early, a PET/CT scan is often ordered.

[9] (2023) - Neoadjuvant therapy may be considered in cases where LCNEC is diagnosed on a preoperative curettage or endometrial biopsy specimen.

Treatment Options for Cervical Large Cell Neuroendocrine Carcinoma

Cervical large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive form of cancer that requires prompt and effective treatment. While there is no standardized treatment protocol, various drug treatments have been explored to manage this condition.

• Platinum-based chemotherapy: Cisplatin and carboplatin are the most commonly used drugs in treating LCNEC of the cervix [5][8]. These platinum-based chemotherapies have shown promise in improving survival rates and reducing tumor size.
• Etoposide: Etoposide, often combined with cisplatin or carboplatin, is another effective treatment option for LCNEC [6][10]. This chemotherapy regimen has been used to treat various types of neuroendocrine tumors, including those of the cervix.
• Irinotecan and cisplatin: Irinotecan, a topoisomerase I inhibitor, has been used in combination with cisplatin for treating LCNEC [4][9]. This chemotherapy regimen may be effective in managing advanced or metastatic disease.

Other Treatment Considerations

While drug treatment is essential, other factors should also be considered when developing a treatment plan for cervical LCNEC:

• Surgery: In some cases, surgery may be necessary to remove the tumor and surrounding tissue [14].
• Hormone therapy: Somatostatin analogs (SSAs) can help manage symptoms related to hormone release from the tumor [13].

Importance of Early Diagnosis and Treatment

Early diagnosis and treatment are crucial in improving outcomes for patients with cervical LCNEC. Given its aggressive nature, prompt initiation of effective treatment is essential to slow disease progression and improve survival rates.

References:

[4] by M Omori · 2014 · Cited by 8 [5] by CB Tempfer · 2018 · Cited by 10 [6] by Yoseph B, Chi M, Truskinovsky AM, Dudek AZ. Large-cell neuroendocrine carcinoma of the cervix. [9] Expanded Access is a potential pathway for a patient with a serious or immediately life-threatening disease or condition to gain access to an investigational medical product (drug, biologic, or medical device) for treatment outside of clinical trials when no comparable or satisfactory alternative therapy options are available. [10] by M Omori · 2014 · Cited by 8 [13] SSAs often serve as the backbone of drug therapy for NETs: Treatment goals: SSAs can provide relief from symptoms related to NET hormone release and stop or slow tumor growth. They work better for tumors with cells that are well-differentiated, meaning they look more or less like normal cells. [14] 1. Introduction. Currently, there is no standardized treatment protocol for large cell neuroendocrine carcinoma of the cervix. Treatment approaches often reference those used for common cervical cancer, small cell neuroendocrine carcinoma of the cervix, and small cell neuroendocrine carcinoma of the lung due to its rarity and aggressive nature, which generally leads to poor prognosis.