Neuroendocrine Carcinoma of the Cervix: A Case Report

Abstract

Neuroendocrine carcinoma of the uterine cervix is a rare and highly aggressive malignancy that accounts for less than 2% of all cervical cancers and is usually associated with human papillomavirus infection. Cases lacking evidence of this association remain uncommon and may present diagnostic difficulty. This case report describes a 60-year-old woman who presented with postmenopausal bleeding. Clinical examination suggested a tumoural cervical lesion, and transvaginal ultrasound identified a heterogeneous cervical mass extending to the uterine body. Pelvic magnetic resonance imaging showed a cervico-isthmic lesion with parametrial extension, while 18F-FDG positron emission tomography/computed tomography demonstrated an intensely hypermetabolic cervical mass and right external iliac lymph node involvement. Histological and immunohistochemical examination of the cervical biopsy confirmed poorly differentiated neuroendocrine carcinoma of the uterine cervix. The tumour showed epithelial marker positivity, partial neuroendocrine marker expression, high Ki-67 proliferative activity, and an unusual p16-negative profile. The disease was classified as FIGO stage IIIC1 according to the 2018 classification. Following multidisciplinary assessment, the patient received induction chemotherapy with etoposide and cisplatin, followed by concurrent chemoradiotherapy and brachytherapy. Post-treatment evaluation demonstrated complete response according to RECIST criteria. This case highlights the diagnostic and therapeutic complexity of p16-negative cervical neuroendocrine carcinoma and underscores the need for integrated morphological, immunohistochemical, and radiological assessment.