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Abstract
Introduction/Background Small cell neuroendocrine carcinoma of the cervix (SCNCC) is an aggressive and rare histological variant. It has a reserved prognosis with 34% survival in 5 years. The most common sites of metastasis are lymph nodes, liver, lung and brain. Cutaneous metastasis are extremely rare, with reported incidence of 0.1%, mostly in surgical incision. Multimodal treatment is usually indicated due to its poor prognosis.
Methodology We present a report of two cases of SCNCC with multiple cutaneous metastasis.
Results Patient 1: Previously healthy 43 years old, with normal screening for cervical cancer 16 months prior to admission, presented with vaginal discharge, pelvic pain and weight loss. Physical exam revealed multiple cutaneous nodules and a bulky cervical tumor. Imaging revealed diffuse lymph node metastasis and numerous cutaneous lesions.
Patient 2: Previously healthy 59 years old, presented with similar symptoms and physical exam, but also a rectovaginal fistula. Imaging revealed metastatic disease to the lymph nodes, peritoneum, bone, brain and numerous cutaneous lesions.
Both patients underwent cervical tumor and cutaneous nodules biopsy, confirming a SCNCC with cutaneous metastasis. Patient 2 had an initial report of Merkel carcinoma and only after pathological review metastatic SCNCC was confirmed. Hypofractioned pelvic radiotherapy was performed to control local symptoms and before initiation of palliative chemotherapy, both evolved quickly to diffuse progressive disease. Chemotherapy with carboplatin associated with paclitaxel and etoposide was initiated and the patient with cerebral metastasis also received whole brain radiotherapy. Patient 1 died of the disease 9 months after diagnosis and patient 2 is alive with disease with a follow-up of 13 months, still receiving palliative treatment.
Left image refers to patient 1 and right image refers to patient 2, both presenting subcutaneous nodules
Conclusion We present 2 cases of an extremely rare presentation of SCNCC with multiple cutaneous metastasis. In this aggressive subtype, meticulous physical exam is paramount and any abnormal finding should prompt further investigation.