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Abstract
Objectives Small cell neuroendocrine carcinoma of the cervix (SCNC) is an aggressive and rare histologic subtype, accounting for less than 2% of all cervical tumors. Moreover, cervical cancer complicated with uterine prolapse is even rarer with an estimated incidence of 0.14–1.0%.
Methods A 32-year-old multipara presented with a 13-month history of intermittent vaginal spotting and postcoital bleeding, associated with gradually increasing introital mass. Pelvic examination revealed procidentia uteri. A foul-smelling fungating, necrotic mass at the anterior lip of the cervix measuring 9 x 9 x 4.5 cm was also noted. Biopsy of the mass and immunohistochemistry were consistent with SCNC. Imaging studies were done to determine the extent of the tumor. A diagnosis of small cell neuroendocrine carcinoma of the cervix, stage IIIC1r with pelvic organ prolapse, stage IVC was made. Uterine procidentia was reduced using a gellhorn pessary. The patient received external beam radiation therapy followed by brachytherapy, and chemotherapy with Cisplatin and Etoposide.
Results There was marked reduction of the cervical mass, and complete resolution of the pelvic organ prolapse, as well.
Conclusions This is the first report of small cell neuroendocrine carcinoma of the cervix complicated with uterine procidentia, locally and internationally. It required a multidisciplinary approach involving a urogynecologist, a gynecologic oncologist, and a radiation oncologist. Standard treatment guidelines for this rare tumor and case are yet to be established.