Introduction/Background Small cell neuroendocrine cervical cancer (NECC) is a rare subtype of cervical cancer. This aggressive tumor accounts for less than 1.5% of all cervical cancers. Simultaneous occurrence of small cell NEC and adenocarcinoma of the uterine cervix is considered to be extremely rare.

Methodology A 35-year-old female patient presented our gynecology department with irregular vaginal bleeding and suspicious lesion of the cervix. Transvaginal ultrasound showed a 3.2 × 1.9 cm cervical mass with a high blood flow. Diagnosis of neuroendocrine carcinoma was made after biopsy specimen of the tumor was analysed. Human papillomavirus (HPV) polymerase chain reaction (PCR) studies revealed HPV type 18 positivity. PET-CT of the abdomen and pelvis showed an exophytic tumour without lymph node metastasis.

Results The patient underwent radical hysterectomy with bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy. Pathological examination confirmed initial diagnosis of small cell neuroendocrine carcinoma of the cervix, with negative surgical margins. Synchronous adenocarcinoma in situ was also identified in transformation zone. The tumoral tissue stained diffusely positive with CKAE1/AE3, CD56, chromogranin, synaptophysin, thyroid transcription factor-1 (TTF-1). Targeted next-generation gene sequencing revealed it was microsatellite stable (MSS) and mutational burden low (TMB - Low) tumor. The patient received adjuvant treatment according to Hoskins protocol. There was no evidence of disease recurrence during a 14-month follow-up period.

Conclusion Simultaneous occurrence of small cell NEC and adenocarcinoma of the uterine cervix is a very rare event and there is no consensus with regard to the optimal treatment strategy. Further research in genetic alterations of these tumors will broaden the spectrum and efficacy of targeted therapy and offer better individualized management strategies.

Disclosure Nothing to disclose.