1
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Saraei P, Heshmati A, Hosseini S. Small-cell neuroendocrine carcinoma of the female genital tract: A comprehensive overview. J Neuroendocrinol 2024; 36:e13394. [PMID: 38626758 DOI: 10.1111/jne.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/15/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
Small-cell neuroendocrine carcinomas (SCNECs) of the female genital tract are rare and aggressive tumors that are characterized by a high rate of recurrence and poor prognosis. They can arise from various sites within the female genital tract, including the cervix, endometrium, ovary, fallopian tube, vagina, and vulva. They are composed of cells with neuroendocrine features, such as the ability to produce and secrete hormones and peptides, and a high mitotic rate. Immunohistochemical staining for neuroendocrine markers, such as chromogranin A, synaptophysin, and CD56, can aid in the diagnosis of these tumors. This article provides an overview of the epidemiology, etiology, and risk factors associated with these tumors, as well as their clinical presentation, cellular characteristics, diagnosis, and finally the current treatment options for SCNECs, including surgery, chemotherapy, and radiation therapy, alone or in combination.
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MESH Headings
- Humans
- Female
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/therapy
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Small Cell/therapy
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/epidemiology
- Carcinoma, Small Cell/pathology
- Genital Neoplasms, Female/therapy
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/epidemiology
- Risk Factors
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Affiliation(s)
- Pouya Saraei
- Department of Medical Physics, Medicine School, Ahvaz Jondishapur University of Medical Sciences, Ahvaz, Iran
| | - Abbas Heshmati
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sare Hosseini
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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2
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Fasanya-Maku H, Petty D, Knapik J, Leon M, Gonsalves C. A case of metastatic HPV-related cervical small cell neuroendocrine carcinoma with varying cytomorphology found in cytological specimens of a solid organ transplant recipient. Diagn Cytopathol 2024. [PMID: 38819099 DOI: 10.1002/dc.25361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
Small cell neuroendocrine carcinoma (NEC) of the cervix is a rare gynecological malignancy, constituting 2%-5% of all such cases. As high-risk Human Papilloma Virus (HR-HPV) infections contribute to 85% of these tumors, small cell NEC poses a significant risk for solid organ transplant recipients, increasing their risk of progressive disease. We present a case of an uterine cervix small cell NEC with metastasis to the bladder and pleural cavities in a 53-year-old woman with a past medical history of kidney transplantation, who presented with abnormal uterine bleeding. The initial liquid preparation (ThinPrep) cytology stained with Papanicolaou (Pap) showed an adenocarcinoma not otherwise specified. At the time of diagnosis, the patient had diffusely metastatic disease. A subsequent uterine cervix biopsy was consistent with a small cell NEC. Despite treatment with chemotherapy, the patient's condition deteriorated, evidenced by a worsening right-sided pleural effusion one-month postdiagnosis. A pleural effusion showed a tumor with glandular features, with immunohistochemistry suggestive of metastatic adenocarcinoma. HR HPV E6/E7 RNA in situ hybridization (ISH) was positive. Bladder washing showed cytopathologic findings consistent with bladder involvement by small cell carcinoma. The patient's lesions in both urine and pleural fluids showed distinct cytomorphology. Within a year of diagnosis, the patient was declared deceased. This case highlights the existence of carcinoma admixed with NEC tumor, such as an HPV associated adenocarcinoma admixed with a NEC and underscores the elevated risk of HPV-related genital lesions in renal transplant patients. In patients with a history of solid organ transplant or other immunosuppressive conditions, there is an increased necessity for enhanced surveillance and appropriate cancer screening.
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Affiliation(s)
- Henrietta Fasanya-Maku
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology, Immunology, &; Lab Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Danielle Petty
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Jaquelyn Knapik
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Marino Leon
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Catherine Gonsalves
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
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3
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Fan KY, Chehade R, Wang AY, Sachdeva A, MacKay HJ, Taggar AS. Pan-Canadian Analysis of Practice Patterns in Small Cell Carcinoma of the Cervix: Insights from a Multidisciplinary Survey. Curr Oncol 2024; 31:2610-2619. [PMID: 38785477 PMCID: PMC11119600 DOI: 10.3390/curroncol31050196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/27/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
Small-cell neuroendocrine carcinoma of the cervix (SCNECC) is a rare cancer with poor prognosis, with limited data to guide its treatment. The objective of this study was to evaluate practice patterns in the management of SCNECC. A 23-question online survey on management of SCNECC was disseminated to Canadian gynecologic oncologists (GO), radiation oncologists (RO) and medical oncologists (MO). In total, 34 practitioners from eight provinces responded, including 17 GO, 13 RO and four MO. During staging and diagnosis, 74% of respondents used a trimodality imaging approach, and 85% tested for neuroendocrine markers. In early-stage (1A1-1B2) SCNECC, 87% of practitioners used a surgical-based approach with various adjuvant and neoadjuvant treatments. In locally advanced (1B3-IVA) SCNECC, 53% favored primary chemoradiation, with cisplatin and etoposide, with the remainder using surgical or radiation-based approaches. In metastatic and recurrent SCNECC, the most common first-line regimen was etoposide and platinum, and 63% of practitioners considered clinical trials in the first line setting or beyond. This survey highlights diverse practice patterns in the treatment of SCNECC. Interdisciplinary input is crucial to individualizing multimodality treatment, and there is a need for prospective trials and intergroup collaboration to define the optimal approach towards managing this rare cancer type.
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Affiliation(s)
- Kevin Yijun Fan
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir., Toronto, ON M5S 1A8, Canada; (K.Y.F.); (R.C.); (A.S.); (H.J.M.)
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, T-wing 2075 Bayview Avenue TG 260, Toronto, ON M4N 3M5, Canada
| | - Rania Chehade
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir., Toronto, ON M5S 1A8, Canada; (K.Y.F.); (R.C.); (A.S.); (H.J.M.)
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, T-wing 2075 Bayview Avenue TG 260, Toronto, ON M4N 3M5, Canada
| | - Andrew Yuanbo Wang
- Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St., London, ON N6A 5C1, Canada;
| | - Anjali Sachdeva
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir., Toronto, ON M5S 1A8, Canada; (K.Y.F.); (R.C.); (A.S.); (H.J.M.)
| | - Helen J. MacKay
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir., Toronto, ON M5S 1A8, Canada; (K.Y.F.); (R.C.); (A.S.); (H.J.M.)
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, T-wing 2075 Bayview Avenue TG 260, Toronto, ON M4N 3M5, Canada
| | - Amandeep S. Taggar
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir., Toronto, ON M5S 1A8, Canada; (K.Y.F.); (R.C.); (A.S.); (H.J.M.)
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, T-wing 2075 Bayview Avenue TG 260, Toronto, ON M4N 3M5, Canada
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4
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Asa SL, Ezzat S. Endocrine tumors of the female reproductive tract. Mol Cell Endocrinol 2024; 582:112123. [PMID: 38135144 DOI: 10.1016/j.mce.2023.112123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
Endocrine cells responsible for hormone secretion are found in virtually every organ system. The diverse neoplasms arising from endocrine cells in the female reproductive tract are not well recognized as a distinct component of endocrine oncology. Here, we integrate cellular origins with native anatomical residence to help classify neoplasms of this system. The neoplasms include steroidogenic tumors that arise usually in ovarian stroma, neuroendocrine neoplasms that can arise from normal neuroendocrine cells throughout the female reproductive tract or in ovarian germ cell tumors, and thyroid follicular cell proliferations that are exclusively a component of an ovarian teratoma and may be malignant. The neuroendocrine neoplasms run the full spectrum from indolent neuroendocrine tumors to aggressive poorly differentiated neuroendocrine carcinomas. While many of these lesions are identified as incidental findings in surgically resected tissues, others present with inappropriate hormone excess. An important consideration is the distinction of primary disease from metastatic malignancy. Genetic disorders including those caused by germline mutations of the FOXL2, GNAS, DICER1, STK11 and MEN1 genes can present with primary endocrine neoplasms of the female reproductive tract.
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Affiliation(s)
- Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, United States.
| | - Shereen Ezzat
- Department of Medicine, Endocrine Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, United States
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5
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Masuda M, Iida K, Iwabuchi S, Tanaka M, Kubota S, Uematsu H, Onuma K, Kukita Y, Kato K, Kamiura S, Nakajima A, Coppo R, Kanda M, Yoshino K, Ueda Y, Morii E, Kimura T, Kondo J, Okada-Hatakeyama M, Hashimoto S, Inoue M. Clonal Origin and Lineage Ambiguity in Mixed Neuroendocrine Carcinoma of the Uterine Cervix. THE AMERICAN JOURNAL OF PATHOLOGY 2024; 194:415-429. [PMID: 38103888 DOI: 10.1016/j.ajpath.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/23/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
Small-cell neuroendocrine carcinoma (SCNEC) of the cervix is a rare disease characterized by a high incidence of mixed tumors with other types of cancer. The mechanism underlying this mixed phenotype is not well understood. This study established a panel of organoid lines from patients with SCNEC of the cervix and ultimately focused on one line, which retained a mixed tumor phenotype, both in vitro and in vivo. Histologically, both organoids and xenograft tumors showed distinct differentiation into either SCNEC or adenocarcinoma in some regions and ambiguous differentiation in others. Tracking single cells indicated the existence of cells with bipotential differentiation toward SCNEC and adenocarcinomas. Single-cell transcriptional analysis identified three distinct clusters: SCNEC-like, adenocarcinoma-like, and a cluster lacking specific differentiation markers. The expression of neuroendocrine markers was enriched in the SCNEC-like cluster but not exclusively. Human papillomavirus 18 E6 was enriched in the SCNEC-like cluster, which showed higher proliferation and lower levels of the p53 pathway. After treatment with anticancer drugs, the expression of adenocarcinoma markers increased, whereas that of SCNEC decreased. Using a reporter system for keratin 19 expression, changes in the differentiation of each cell were shown to be associated with the shift in differentiation induced by drug treatment. These data suggest that mixed SCNEC/cervical tumors have a clonal origin and are characterized by an ambiguous and flexible differentiation state.
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Affiliation(s)
- Masamune Masuda
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keita Iida
- Laboratory of Cell Systems, Institute for Protein Research, Osaka University, Osaka, Japan
| | - Sadahiro Iwabuchi
- Department of Molecular Pathophysiology, Institute of Advanced Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mie Tanaka
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoshi Kubota
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan; Department of Biochemistry, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyuki Uematsu
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kunishige Onuma
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoji Kukita
- Department of Molecular and Medical Genetics, Osaka International Cancer Institute, Osaka, Japan
| | - Kikuya Kato
- Department of Molecular and Medical Genetics, Osaka International Cancer Institute, Osaka, Japan
| | - Shoji Kamiura
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Aya Nakajima
- Department of Biochemistry, Osaka International Cancer Institute, Osaka, Japan; Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Roberto Coppo
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mizuki Kanda
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jumpei Kondo
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Biochemistry, Osaka International Cancer Institute, Osaka, Japan
| | | | - Shinichi Hashimoto
- Department of Molecular Pathophysiology, Institute of Advanced Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Inoue
- Department of Clinical Bio-resource Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Biochemistry, Osaka International Cancer Institute, Osaka, Japan.
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6
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Kim G, Kim M, Nam EJ, Lee JY, Park E. Application of Small Cell Lung Cancer Molecular Subtyping Markers to Small Cell Neuroendocrine Carcinoma of the Cervix: NEUROD1 as a Poor Prognostic Factor. Am J Surg Pathol 2024; 48:364-372. [PMID: 37981832 DOI: 10.1097/pas.0000000000002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Cervical small cell neuroendocrine carcinoma (CSCNEC) is a rare, aggressive type of cervical cancer. The treatment for CSCNEC follows the chemotherapeutic regimens used for small cell lung cancer (SCLC), with which it shares similar clinical and histologic features. For the first time, we applied neuroendocrine (NE) and SCLC molecular subtyping immunohistochemical markers [achaete-scute homolog 1 (ASCL1), neurogenic differentiation factor 1 (NEUROD1), POU class 2 homeobox 3 (POU2F3), and yes-associated protein 1] in 45 patients with CSCNEC. For the combined NE score, 51.1% of NE-high and 48.9% of NE-low subtypes were identified. The NE-high subtype tended to show worse progression-free survival and overall survival (OS) than the NE-low subtype ( P =0.059 and P =0.07, respectively). Applying the SCLC molecular subtyping, 53.3% of cases were identified as NEUROD1-dominant, 17.8% as ASCL1-dominant, 13.3% as YAP-dominant, and 4.4% as POU2F3-dominant, while 11.1% of cases showed negative expression for all markers; the distribution was different from that of SCLC. The NEUROD1-dominant subtype exhibited the worst OS, while the POU2F3 subtype exhibited the best OS ( P =0.003), similar to SCLC. In addition, the ASCL1-dominant and NEUROD1-dominant subtypes showed high NE scores, while yes-associated protein 1-dominant and POU2F3-dominant subtypes showed low NE scores ( P =0.008). In multivariate analysis, the NEUROD1 expression was further identified as the independent prognostic factor for worse OS, together with the high FIGO stage. CSCNEC was revealed to be a heterogeneous disease with different biological phenotypes and to share some similarities and differences with SCLC. Regarding the ongoing development of tailored treatments based on biomarkers in SCLC, the application of biomarker-driven individualized therapy would improve clinical outcomes in patients with CSCNEC.
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Affiliation(s)
- Gilhyang Kim
- Department of Pathology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Milim Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunhyang Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea
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7
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Lamiman K, Wilhelm AB, Eyzaguirre E, Richardson G. Diagnostic Challenges and Long-term Outcomes of Neuroendocrine Carcinoma of the Cervix: A Case Series. Int J Gynecol Pathol 2024; 43:149-157. [PMID: 37922936 PMCID: PMC10852037 DOI: 10.1097/pgp.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Neuroendocrine carcinomas (NECs) of the cervix are rare, aggressive malignancies that are challenging to diagnose and treat. They are high-grade lesions that often share features with poorly differentiated adenocarcinoma and squamous cell carcinoma. NECs are classified into large-cell or small-cell subtypes but can often have a mixed appearance or occur concurrently with a squamous or adenocarcinoma. Diagnosis is dependent on tissue sampling, histomorphology, and immunohistochemistry. Eight cases of NEC were retrieved from the Department of Pathology at our institution from 2008 to 2022. Tumor slides were reviewed and evaluated by 2 independent pathologists. Seven of 8 patients tested positive for neuroendocrine markers, including CD56, synaptophysin, and chromogranin. We discuss the diagnostic challenges, review the histopathology, and describe the treatment courses and clinical outcomes. This case series reveals that traditional markers, such as p16, p63, and p40, may be focally positive in NEC and should not be considered a confirmation of squamous cell carcinoma. Patient outcomes can be affected by delays in diagnosis, misdiagnosis, and inadequate treatment when NEC is not considered in the initial differential diagnosis.
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8
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Barcellini A, Golia D'Augè T, Mandato VD, Cuccu I, Musella A, Fruscio R, Vitale MG, Martinello R, Mangili G, Pignata S, Palaia I. Primary neuroendocrine neoplasms of the vulva: A review of the MITO rare cancer group. Crit Rev Oncol Hematol 2024; 193:104201. [PMID: 37977312 DOI: 10.1016/j.critrevonc.2023.104201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
Gynecological neuroendocrine neoplasms are rare entities and can be divided into two groups: carcinoids and neuroendocrine carcinomas. Due to their rarity their management is not standardized. The aim of this work is to summarize and discuss the current literature evidence on this pathology. A scoping literature review was performed in multiple databases. Thirty-one studies were included: 30 case reports and one case series. Patients' age ranged between 28 and 92 years. Surgery was the most used treatment and the surgical approach included local excision (N = 16/31; 51.6%) with (N = 5/16; 31.25%) or without (N = 11/16; 68.75%) inguinal lymphadenectomy. Adjuvant radiotherapy was delivered in 12 (38.7%) cases; instead, platinum-based therapies were frequently used when chemotherapy was chosen for adjuvant treatment. The overall survival ranged between 20 days to 4 years. However, further research is needed; currently, multimodal approach including surgery, chemotherapy and radiotherapy appeared safe and feasible for the treatment of these rare and aggressive diseases.
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Affiliation(s)
- Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Tullio Golia D'Augè
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy.
| | - Vincenzo Dario Mandato
- Unit of Obstetrics and Gynaecology, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Ilaria Cuccu
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Angela Musella
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Robert Fruscio
- University of Milan Bicocca, IRCCS San Gerardo, Monza, Italy
| | - Maria Giuseppa Vitale
- Department of Oncology and Hematology, University Hospital of Modena, 41100 Modena, Italy
| | - Ruby Martinello
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Italy
| | - Giorgia Mangili
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, IRCCS Milan, Italy
| | - Sandro Pignata
- Uro-Gynecological Medical Oncology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
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9
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Fattorini C, Rocca BJ, Giusti A, Arganini M, Perotti B, Cavazzana A, Ambrosio MR, Volante M. Mixed mucinous adenocarcinoma/large cell neuroendocrine carcinoma of the uterine cervix: case report and molecular characterization of a rare entity. Virchows Arch 2024; 484:141-146. [PMID: 36988712 PMCID: PMC10052266 DOI: 10.1007/s00428-023-03532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Mixed neuroendocrine-non-neuroendocrine carcinomas of the cervix are rare and generally aggressive diseases. They often present at an advanced stage with hematogenous or lymphatic metastases. The prognosis is poor, mostly influenced by the neuroendocrine component. Unfortunately, the rarity of the disease caused a lack of information about its pathogenesis and molecular landscape. The latest guidelines recommend a multimodal approach that usually includes radical surgery, platinum/etoposide-based chemotherapy, or chemoradiation. Here, we are presenting a case of metastatic mixed adenocarcinoma-large cell neuroendocrine carcinoma of the cervix in a 49-year-old female patient. The molecular characterization of the lesion highlighted the ubiquitous presence of human papillomavirus-18 DNA both in the adenocarcinomatous and the neuroendocrine components, suggesting a role for the virus in the pathogenesis. Moreover, a different set of mutations was detected in the two parts, thus ruling out a possible clonal evolution of the neuroendocrine component from the adenocarcinoma one. More studies are needed to clarify the molecular landscape of these rare lesions and identify putative targets for therapy.
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Affiliation(s)
- Caterina Fattorini
- Pathology Unit, Azienda Sanitaria Toscana Nord Ovest, Via Cocchi 1, 56121, Pisa, Italy
| | - Bruno J Rocca
- Pathology Unit, Azienda Sanitaria Toscana Nord Ovest, Via Cocchi 1, 56121, Pisa, Italy
| | - Andrea Giusti
- Pathology Unit, Azienda Sanitaria Toscana Nord Ovest, Via Cocchi 1, 56121, Pisa, Italy
| | - Marco Arganini
- Surgery Unit, Ospedale Unico Versilia, Azienda Sanitaria Toscana Nord Ovest, 56121, Pisa, Italy
| | - Bruno Perotti
- Surgery Unit, Ospedale Unico Versilia, Azienda Sanitaria Toscana Nord Ovest, 56121, Pisa, Italy
| | - Andrea Cavazzana
- Pathology Unit, Azienda Sanitaria Toscana Nord Ovest, Via Cocchi 1, 56121, Pisa, Italy
| | - Maria R Ambrosio
- Pathology Unit, Azienda Sanitaria Toscana Nord Ovest, Via Cocchi 1, 56121, Pisa, Italy.
| | - Marco Volante
- Pathology Unit, Department of Oncology at San Luigi Hospital, University of Turin, Orbassano, Italy
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10
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Stumpo S, Formelli MG, Persano I, Parlagreco E, Lauricella E, Rodriquenz MG, Guerrera LP, Zurlo IV, Campana D, Brizzi MP, Cives M, La Salvia A, Lamberti G. Extrapulmonary Neuroendocrine Carcinomas: Current Management and Future Perspectives. J Clin Med 2023; 12:7715. [PMID: 38137784 PMCID: PMC10743506 DOI: 10.3390/jcm12247715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Neuroendocrine carcinomas (NECs) are poorly differentiated and highly aggressive epithelial neuroendocrine neoplasms. The most common primary site is the lung, but they may arise in every organ. Approximately 37% of extrapulmonary NECs (EP-NECs) occur in the gastroenteropancreatic (GEP) tract, followed by the genitourinary (GU) system and gynecological tract. As a result of their rarity, there is scant evidence to guide treatment recommendations, and a multidisciplinary approach is essential for the management of such patients. Platinum-based chemotherapy currently represents the standard of care for EP-NECs of any site, mirroring the management of small-cell lung cancer (SCLC), but further approaches are still under investigation. Indeed, ongoing trials evaluating targeted therapies, immune checkpoint inhibitors (ICIs), and radionuclide therapy could provide potentially breakthrough therapeutic options. Given the relative dearth of evidence-based literature on these orphan diseases, the aim of this review is to provide an overview of the pathology and current treatment options, as well as to shed light on the most pressing unmet needs in the field.
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Affiliation(s)
- Sara Stumpo
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
| | - Maria Giovanna Formelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
| | - Irene Persano
- Medical Oncology, AO S. Croce e Carle, 12100 Cuneo, Italy; (I.P.); (E.P.)
| | - Elena Parlagreco
- Medical Oncology, AO S. Croce e Carle, 12100 Cuneo, Italy; (I.P.); (E.P.)
| | - Eleonora Lauricella
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (E.L.); (M.C.)
| | - Maria Grazia Rodriquenz
- Oncology Unit, Ospedale IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Luigi Pio Guerrera
- Division of Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
- Sarcomas and Rare Tumors Unit, Istituto Nazionale Tumori, IRCCS-Fondazione “G. Pascale”, 80131 Naples, Italy
| | | | - Davide Campana
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Maria Pia Brizzi
- Department of Oncology, A.O.U. San Luigi Gonzaga Hospital, 10043 Orbassano, Italy;
| | - Mauro Cives
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (E.L.); (M.C.)
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), 00161 Rome, Italy
| | - Giuseppe Lamberti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
- Medical Oncology Unit, Vito Fazzi Hospital, 73100 Lecce, Italy;
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11
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Chen X, Shi W, Wang C, Zhu H. Personalized prognostic prediction tool for high-grade neuroendocrine cervical cancer: a SEER database analysis and single-center validation. J Cancer Res Clin Oncol 2023; 149:17395-17404. [PMID: 37853082 PMCID: PMC10657306 DOI: 10.1007/s00432-023-05414-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Cervical high-grade neuroendocrine carcinoma (CHGNEC) is a rare but highly aggressive cancer. The purpose of this study is to develop a prognostic nomogram that can accurately predict the outcomes for CHGNEC patients. METHODS We analyzed clinical data from the Surveillance, Epidemiology, and End Results (SEER) database of CHGNEC patients, including small-cell neuroendocrine carcinoma (SCNEC) and large-cell neuroendocrine carcinoma (LCNEC). We investigated patient characteristics and prognosis, and developed a prognostic nomogram model for cancer-specific survival in CHGNEC patients. External validation was conducted using real clinical cases from our hospital. RESULTS Our study included 306 patients from SEER database, with a mean age of 49.9 ± 15.5 years. Most of the patients had SCNEC (86.9%). Among them, 170 died from the disease, while 136 either survived or died from other causes. Our final predictive model identified age at diagnosis, stage 1 status, stage 4 status, T1, N0, and surgery of the primary site as independent prognostic factors for CHGNEC. We validated our model using a group of 16 CHGNEC patients who underwent surgery at our center. The external validation showed that the prognostic nomogram had excellent discriminative ability, with an area under the receiver operating characteristic curve (AUC) of 0.76 (95% CI 0.49-1.00) for the prediction of 3-year cancer-specific survival (CSS) and an AUC of 0.85 (95% CI 0.62-1.00) for the prediction of 5-years CSS. The random survival forest model achieved an AUC of 0.80 (95% CI 0.56-1.00) for 3-years CSS and 0.91 (95% CI 0.72-1.00) for 5-years CSS, indicating its adequacy in predicting outcomes for CHGNEC patients. CONCLUSION Our study provides an excellent nomogram for predicting the prognosis of CHGNEC patients. The prognostic nomogram can be a useful tool for clinicians in identifying high-risk patients and making personalized treatment decisions.
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Affiliation(s)
- Xiaoyue Chen
- Gynecological Department, Shanghai First Maternity and Infant Health Hospital, No. 2699 West Gao Ke Road, Pudong, Shanghai, China
| | - Wenpei Shi
- Clinical Research Unit, Shanghai First Maternity and Infant Health Hospital, Shanghai, China
| | - Chao Wang
- Gynecological Department, Shanghai First Maternity and Infant Health Hospital, No. 2699 West Gao Ke Road, Pudong, Shanghai, China
| | - Haiyan Zhu
- Gynecological Department, Shanghai First Maternity and Infant Health Hospital, No. 2699 West Gao Ke Road, Pudong, Shanghai, China.
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12
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Morcet-Delattre R, Espenel S, Tas P, Chargari C, Escande A. Role of radiotherapy in the management of rare gynaecological cancers. Cancer Radiother 2023; 27:778-788. [PMID: 37925347 DOI: 10.1016/j.canrad.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 11/06/2023]
Abstract
There are a large number of gynaecological cancers with rare histologies, for which the available data are limited and usually retrospective. Because of their rarity and poor prognosis, the management of these cancers must be centralized in expert centres, for both histological diagnosis and treatment. With the exception of sarcomas, most endometrial or cervical cancers with rare histologies respond to the same radiation treatment modalities than cancers with more common histologies, although there are some specificities regarding treatments such as neuroendocrine carcinomas (chemotherapy with platinum and etoposide, major role of surgery). For localized or locally advanced ovarian cancer, external beam radiotherapy has a role in the management of hypercalcaemic small cell carcinoma of the ovary. This article summarizes the current role of external beam radiotherapy and brachytherapy in the management of cancers of the uterine cervix, uterine corpus and ovaries, with rare or very rare histologies, and with localized or locally advanced stages.
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Affiliation(s)
- R Morcet-Delattre
- Radiation oncology department, centre Eugène-Marquis, Rennes, France.
| | - S Espenel
- Radiation oncology department, Gustave-Roussy Cancer Campus, Villejuif, France
| | - P Tas
- Anatomopathology department, Ouest pathologie, Rennes, France
| | - C Chargari
- Radiation oncology department, groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - A Escande
- Radiation oncology department, centre Léonard-de-Vinci, Dechy, France; Laboratoire CRIStAL UMR9189, université de Lille, CNRS, Lille, France
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13
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Gurubalan G, Parwaiz A, Ajit S, Kumar T, Kumari M, Bhadani P. Small cell neuroendocrine carcinoma with adenocarcinoma and high grade squamous intraepithelial neoplasia of the cervix. Autops Case Rep 2023; 13:e2023452. [PMID: 38034519 PMCID: PMC10688200 DOI: 10.4322/acr.2023.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/17/2023] [Indexed: 12/02/2023]
Abstract
Neuroendocrine neoplasm (NEN) of the cervix is a malignant tumor and is classified into low and intermediate-grade neuroendocrine tumor (NET), and high-grade small cell neuroendocrine carcinoma (SCNEC), and large cells neuroendocrine carcinoma (LCNEC). SCNEC of the cervix is an Infrequent tumor with an incidence of less than 1% of all gynecological malignancies. It is characterized by small to medium-sized tumor cells with scant cytoplasm and neuroendocrine differentiation. Most cases of SCNEC of the cervix manifest in pure forms, and only cases show coexisting, non-neuroendocrine component of HPV-associated adenocarcinoma or squamous cell carcinoma. In this report, reviewing the literature, we present one such unique case of SCNEC of the cervix with adenocarcinoma and high-grade squamous intraepithelial neoplasia.
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Affiliation(s)
| | - Amber Parwaiz
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Surabhi Ajit
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Tarun Kumar
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Madhu Kumari
- All India Institute of Medical Sciences, Patna, Bihar, India
| | - Punam Bhadani
- All India Institute of Medical Sciences, Patna, Bihar, India
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14
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Kwon GJ, Jorgensen JR, Vedere TR, Sanders M, Nam G. Rare Primary Fallopian Tube Grade 2 Neuroendocrine Tumor: A Case Report With Review of Literature. Int J Gynecol Pathol 2023; 42:632-639. [PMID: 36867495 DOI: 10.1097/pgp.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Neuroendocrine neoplasms commonly arise from the gastrointestinal tract and lungs. Less commonly, they may occur in the gynecologic tract, typically within the ovary of a mature cystic teratoma. Primary neuroendocrine neoplasms of the fallopian tube are exceptionally rare and only a total of 11 cases have been reported in the literature. We describe the first case to our knowledge of a primary grade 2 neuroendocrine tumor of the fallopian tube in a 47-yr-old female. In this report, we describe the case's unique presentation, review the published literature on primary neuroendocrine neoplasms of the fallopian tube, discuss the treatment options, and speculate on their origin and histogenesis.
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15
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Chao A, Wu RC, Lin CY, Chang TC, Lai CH. Small cell neuroendocrine carcinoma of the cervix: From molecular basis to therapeutic advances. Biomed J 2023; 46:100633. [PMID: 37467967 PMCID: PMC10522988 DOI: 10.1016/j.bj.2023.100633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/02/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023] Open
Abstract
Small cell neuroendocrine carcinoma of the cervix (SCNECC) is an uncommon but aggressive uterine malignancy, the cause of which is generally associated with human papillomavirus (HPV) infection. A lack of clinical trials and evidence-based treatment guidelines poses therapeutic challenges to this rare tumor. At present, published data remain limited to case series and case reports. While clinical management has traditionally followed those of small cell neuroendocrine (SCNE) lung cancer relying on surgery, chemoradiation, and systemic chemotherapy, the prognosis remains dismal. Immune checkpoint inhibitors (ICIs), such as monoclonal antibodies that target programmed death-1 (PD-1) or programmed death-ligand 1 (PD-L1), atezolizumab and durvalumab have proven effective in extensive-stage SCNE lung cancer. Moreover, pembrolizumab has also proven beneficial effects when added onto chemotherapy in metastatic and recurrent HPV-associated non-SCNE cervical cancer. It holds promise to use ICIs in combination with chemoradiation to improve the clinical outcomes of patients with SCNECC. Future advances in our understanding of SCNECC biology - associated with the study of its genomic and molecular aberrations as well as knowledge from SCNE of lung and other extrapulmonary sites- would be helpful in discovering new molecular targets for drug development. Collaborative efforts and establishment of a SCNECC-specific biobank will be essential to achieve this goal.
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Affiliation(s)
- Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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16
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Tangella AV, Yadlapalli DC. Neuroendocrine Carcinoma of Cervix: A Case Series. Cureus 2023; 15:e39165. [PMID: 37332440 PMCID: PMC10276186 DOI: 10.7759/cureus.39165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Cervical cancer is the second most common cause of cancer-related mortality in women globally. Neuroendocrine carcinomas are among the rarest and least studied histopathological types of cervical cancers, accounting for 1.4% of all cervical cancers. Neuroendocrine carcinomas of the cervix (NECCs) are aggressive tumors that can be associated with several high-risk features such as early lymphovascular invasion and multiple systemic metastases, at early stages. Here, we present a case series of five patients with NECC who have been diagnosed and managed at a tertiary care hospital in coastal Andhra Pradesh, South India. Using the hospital records, we made a list of patients with NECC who were diagnosed by histopathological findings between 2019 and 2022. Details regarding their demographic variables, presenting complaints, staging, and treatment given were noted down using a pre-defined proforma.
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Affiliation(s)
- Adarsh Vardhan Tangella
- Internal Medicine, Andhra Medical College and King George Hospital, Visakhapatnam, IND
- Medical Oncology, GSL (Ganni Subbulakshmi Garu) Cancer Trust Hospital, Rajamahendravaram, IND
| | - Deepak C Yadlapalli
- Medical Oncology, GSL (Ganni Subbulakshmi Garu) Medical College, Rajamahendravaram, IND
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17
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Rajasekaran S, Gupta P, Gupta N. Liquid-based cytology and immunocytochemistry in the evaluation of a vault lesion in a postmenopausal woman. Cytopathology 2023; 34:169-172. [PMID: 36495047 DOI: 10.1111/cyt.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/16/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Cytological features of small cell neuroendocrine carcinoma of the cervix in a liquid-based preparation from a vault lesion.
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Affiliation(s)
- Sangamitra Rajasekaran
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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18
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Flores Legarreta A, Salvo G, Gonzales NR, Chisholm G, Hillman RT, Frumovitz M. RB1 alteration and poor prognosis in women with high-grade neuroendocrine carcinoma of the uterine cervix: a NeCTuR study. J Gynecol Oncol 2023:34.e50. [PMID: 36807750 DOI: 10.3802/jgo.2023.34.e50] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To describe the gene alteration status in high-grade neuroendocrine cervical carcinoma (NECC) specimens and to explore the potential association of unique gene alterations with survival. METHODS Results from tumor-based molecular testing on specimens from women with high-grade NECC in the Neuroendocrine Cervical Tumor Registry were reviewed and analyzed. Tumor specimens could be from primary or metastatic sites and obtained at initial diagnosis, during treatment, or at recurrence. RESULTS Molecular testing results were available for 109 women with high-grade NECC. The genes most frequently mutated were PIK3CA (mutated in 18.5% of patients), TP53 (17.4%), and MYC (14.5%). Other targetable alterations identified were alterations in KIT (7.3%), KRAS (7.3%), and PTEN (7.3%). Women with tumors having an RB1 alteration (6.4%) had a median overall survival (OS) of 13 months, compared to 26 months for women with tumors that did not have an RB1 alteration (p=0.003). None of the other genes evaluated were shown to be associated with OS. CONCLUSION Although no individual alteration was found in a majority of tumor specimens from patients with high-grade NECC, a large proportion of women with this disease will have at least one targetable alteration. Treatments based on these gene alterations may offer additional targeted therapies for women with recurrent disease, who currently have very limited therapeutic options. Patients with tumors that harbor RB1 alterations have decreased OS.
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Affiliation(s)
- Alejandra Flores Legarreta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Gloria Salvo
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naomi R Gonzales
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary Chisholm
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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19
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Xu F, Yu Q, Wan D, Zhang Y. Cervical adenocarcinoma admixing with large cell neuroendocrine carcinoma: A rare case report. Asian J Surg 2022; 45:2932-2933. [PMID: 35778245 DOI: 10.1016/j.asjsur.2022.06.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Fang Xu
- Department of Pathology, Affiliated Hospital of North Sichuan Medical College, 637000, Nɑnchonɡ, China; Department of Pathology, The First People's Hospital of Zigong, 643000, Zigong, China
| | - Qin Yu
- Department of Pathology, The First People's Hospital of Zigong, 643000, Zigong, China
| | - Dan Wan
- Department of Pathology, The First People's Hospital of Zigong, 643000, Zigong, China
| | - Yutao Zhang
- Department of Pathology, Affiliated Hospital of North Sichuan Medical College, 637000, Nɑnchonɡ, China; Department of Pathology, The First People's Hospital of Zigong, 643000, Zigong, China.
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20
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Liu R, He X, Li Z. Positive clinical outcomes following therapy with programmed cell death protein 1/programmed cell death ligand 1 inhibitors in neuroendocrine carcinoma of the cervix. Front Pharmacol 2022; 13:1029598. [DOI: 10.3389/fphar.2022.1029598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Neuroendocrine carcinoma of the cervix (NECC) is a highly aggressive and rare gynecological malignancy with a poor prognosis. Despite aggressive local and systemic treatments, there are high rates of locoregional recurrence and distant metastases. Therefore, more potent treatments are required to manage NECC. In recent years, emerging immune checkpoint inhibitors, such as programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors, have been used in treating various solid tumors and provide a new direction for immune-targeted therapy for NECC. In this review, we summarize the biomarkers useful for the evaluation of the therapy with PD-1/PD-L1 inhibitors in patients with NECC and the clinical applications and prospects of monotherapy with PD-1/PD-L1 inhibitors and combinations with other therapies in patients with NECC. In some individual case reports, therapeutic strategies with PD-1/PD-L1 inhibitors showed good efficacy. Further studies are needed to confirm the possibility of using PD-1/PD-L1 inhibitors as a standard treatment strategy in NECC.
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21
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Marchocki Z, Swift B, Covens A. Small Cell and Other Rare Histologic Types of Cervical Cancer. Curr Oncol Rep 2022; 24:1531-1539. [PMID: 35947285 DOI: 10.1007/s11912-022-01316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper was to summarize the recent evidence on rare subtypes of cervical cancer including small-cell carcinoma of the cervix (SCCC), gastric-type adenocarcinoma, and carcinosarcoma. RECENT FINDINGS All three cervical cancer subtypes are aggressive with poor treatment response and high recurrence rates. Molecular studies have identified various actionable mutations in both SCCC (PIK3CA, MYC, TP53, PTEN, ARID1A, KRAS, BRCA2) and gastric-type adenocarcinoma (KRAS, ARID1A, PTEN). While there are a limited number of case reports demonstrating a favorable response for recurrent SCCC to immune checkpoint inhibitors, a larger case series failed to show benefit. The checkpoint inhibitors role in gastric-type adenocarcinoma and carcinosarcoma is yet to be determined. Ninety-one percent of SCCC cases show PARP expression, suggesting a possible role for PARP inhibitors; however, this has yet to be examined in future clinical trials. More studies are needed, with a focus on targeted therapies. The role of PARP inhibitors in SCCC is potentially promising, but significant collaboration between centers/groups will be required to achieve this.
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Affiliation(s)
- Zibi Marchocki
- Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada
| | - Brenna Swift
- Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada
| | - Allan Covens
- Division of Gynecologic Oncology, Sunnybrook, Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada.
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22
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Pongsuvareeyakul T, Garcia-Moliner M, Lokich E, Dizon DS, Singh K. Small cell neuroendocrine carcinoma of vagina: Report of a unique case with literature review. Cancer Treat Res Commun 2022; 33:100645. [PMID: 36274474 DOI: 10.1016/j.ctarc.2022.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/12/2022] [Accepted: 10/02/2022] [Indexed: 11/27/2022]
Abstract
Small cell carcinoma (SCC) of vagina is extremely rare. The association between this tumor and high-risk HPV infection is unclear. To our knowledge, HPV status has been reported in only 3 previous cases of SCC of vagina. Herein, we present a unique case of vaginal small cell carcinoma with discordant HPV testing results between vaginal and cervical samples. We also review and discuss findings from previously reported cases of small cell carcinoma of vagina.
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Affiliation(s)
- Tip Pongsuvareeyakul
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island, United States
| | - Maria Garcia-Moliner
- Department of Pathology and Laboratory Medicine Rhode Island Hospital, Providence, Rhode Island, United States
| | - Elizabeth Lokich
- Department of Women Oncology Women & Infants Hospital of Rhode Island, Brown University, Providence, Rhode Island, United States
| | - Don S Dizon
- Department of Medicine Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Kamaljeet Singh
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island, United States.
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23
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Gordhandas S, Schlappe BA, Zhou Q, Iasonos A, Leitao MM, Park KJ, de Brot L, Alektiar KM, Sabbatini PJ, Aghajanian CA, Friedman C, Zivanovic O, O'Cearbhaill RE. Small cell neuroendocrine carcinoma of the cervix: Analysis of prognostic factors and patterns of metastasis. Gynecol Oncol Rep 2022; 43:101058. [PMID: 35967833 PMCID: PMC9365998 DOI: 10.1016/j.gore.2022.101058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022] Open
Abstract
A two-tier system (limited- or extensive-stage) has been used for small cell neuroendocrine carcinomas of the cervix. Concordance probability estimates found that the 2018 FIGO staging system predicted outcome better than the two-tier system. 38% of patients had metastases at initial diagnosis, and an additional 38% at subsequent recurrence. 38 patients (60%) had brain imaging: 1 (3%) had brain metastasis at diagnosis and 8 (21%) at subsequent recurrence. Providers should have a low threshold for brain imaging in patients with advanced disease or neurologic symptoms.
Objectives To describe characteristics and outcomes of patients with small cell neuroendocrine carcinoma of the cervix (SCNCC) and determine the staging system most predictive of outcome—the two-tier (limited-stage [LS] vs. extensive-stage [ES]) or International Federation of Gynecology and Obstetrics (FIGO) staging system. Methods Patients with SCNCC evaluated at our institution from 1/1/1990–6/30/2021 were included. Medical records were reviewed for variables of interest. Appropriate statistical tests were performed to determine associations. Survival curves were created using the Kaplan-Meier method. Concordance probability estimates (CPEs) were calculated to evaluate the prediction probability of the staging systems. Results Of 63 patients, 41 had LS and 22 ES SCNCC. Patients with ES disease were significantly older than those with LS disease (median, 54 and 37 years, respectively; p < 0.001). Smoking status, race, and history of HPV were not associated with stage or outcomes. Forty-eight patients had metastatic disease (24 [50%] at initial diagnosis). The most common first sites of metastasis were lung (n = 20/48, 42%), lymph nodes (n = 19/48, 40%), and liver (n = 13/48, 27%). Nine patients had brain metastasis (8 symptomatic at recurrence; 1 asymptomatic at initial diagnosis). Both staging systems were associated with progression-free and overall survival. Adjusted CPE found the FIGO staging system was more predictive of outcomes than the two-tier staging system. Conclusions Providers should have a low threshold to obtain brain imaging for patients with SCNCC, especially in the presence of visceral metastases. FIGO staging should be used to classify SCNCC. Further research is necessary to understand prognostic factors of this rare disease.
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Affiliation(s)
- Sushmita Gordhandas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brooke A. Schlappe
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Currently at: Gynecologic Oncology, Department of Surgery, Aurora Health Care, Milwaukee, WI, USA
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M. Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Kay J. Park
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Louise de Brot
- A.C. Camargo Cancer Center, Anatomic Pathology Department, São Paulo, Brazil
| | - Kaled M. Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul J. Sabbatini
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Carol A. Aghajanian
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Claire Friedman
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Roisin E O'Cearbhaill
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Corresponding author: Gynecology Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275, York Avenue, New York, NY 10065, USA.
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Katafuchi T, Kawakami F, Iwagoi Y, Saito F, Mikami Y. "Neuroendocrine Tumor Grade 3 (NET G3)" of the Uterine Cervix: A Report of 2 Cases. Int J Gynecol Pathol 2022; 41:470-475. [PMID: 34570015 DOI: 10.1097/pgp.0000000000000828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the fifth edition of the World Health Organization classification of female genital tumors, neuroendocrine neoplasms are subcategorized as neuroendocrine tumors (NETs) of grade 1 (G1) and G2, and neuroendocrine carcinoma. NET G3 is not included, as it is for classification of pancreas tumors. Herein, we report 2 cases of "NET G3" of the uterine cervix with long-term follow-up. The patients are 40- and 36-yr-old women who presented with polypoid masses on the uterine cervix. Microscopic examination of hysterectomy specimens revealed tumor features similar to those of pancreatic NET G3 and intestinal type mucinous carcinoma cells invading the cervical stroma. In both cases, the NET component was positive for synaptophysin and chromogranin A, and negative for TTF-1. Mitotic counts were <1/2 mm 2 and 5/2 mm 2 , and the Ki-67 labeling indexes were 57% and 39%, respectively. Pathologic stage classifications (AJCC, version 9) were pT1b1, pN0, and cM0 (FIGO stage IB1), and both patients received adjuvant therapy. One patient had lung and pancreas metastases 4 to 8 yr after initial surgery, which were surgically removed. Both patients remain alive without evidence of recurrent disease 6 and 16 yr after initial surgery. The indolent clinical courses of these cases appear to indicate that cervical "NET G3" is biologically closer to NET than neuroendocrine carcinoma; thus, including uterine cervical "NET G3" in the classification may be justified. However, the optimal management for this tumor type remains undetermined.
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Sah S, Borkar PV, Wight C, Kelly P, Park KJ, McCluggage WG. Low-grade Neuroendocrine Tumor of the Cervix: Report of 3 Cases of a Rare Neoplasm With Review of the Literature. Int J Gynecol Pathol 2022; 41:437-446. [PMID: 35075048 PMCID: PMC9309179 DOI: 10.1097/pgp.0000000000000851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuroendocrine neoplasms are uncommon in the cervix with almost all representing neuroendocrine carcinomas (NECs), either small cell or large cell type. Cervical low-grade neuroendocrine tumors (NETs) are extremely rare with few recent reports using contemporary modern diagnostic criteria. We report 3 cases of cervical NET in patients aged 32 to 57 yr and undertake a review of the literature. The first case was a pure grade 2 NET with pelvic lymph node metastasis (FIGO stage IIIC1). In the second case, a grade 1 NET was associated with high-grade squamous intraepithelial lesion, adenocarcinoma in situ and human papillomavirus (HPV)-associated adenocarcinoma and was FIGO stage IA1. The third patient underwent chemoradiotherapy following a biopsy diagnosis of a high-grade NEC which was radiologically FIGO stage IIIC1 and salvage hysterectomy revealed residual tumor with features of a grade 1 NET. In all cases, the NET was diffusely positive with at least 2 of the neuroendocrine markers chromogranin, synaptophysin, and CD56. The first tumor was p16 negative and the third exhibited block-type immunoreactivity. Molecular tests revealed high risk HPV types 18 and 51 in the third case but no HPV in the first case. p16 immunohistochemistry and HPV molecular testing was not available in the second case. The patients remain disease free with follow-up ranging from 2 to 8 yr. Since a combination of NET and NEC is extremely rare at all sites due to a different pathogenesis, we speculate that in the third case, the NET developed out of the NEC as a "maturation" phenomenon secondary to chemoradiotherapy.
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Affiliation(s)
- Shatrughan Sah
- Department of Histopathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Pallavi Vijay Borkar
- Department of Histopathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Catherine Wight
- Department of Histopathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Paul Kelly
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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Ipilimumab and nivolumab for recurrent neuroendocrine cervical carcinoma. Gynecol Oncol Rep 2022; 42:101039. [PMID: 35846558 PMCID: PMC9284394 DOI: 10.1016/j.gore.2022.101039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/17/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
Neuroendocrine carcinoma of the cervix is a rare and aggressive HPV-mediated malignancy with a high recurrence rate. Combination ipilimumab and nivolumab has been shown to effect disease response in pulmonary neuroendocrine carcinoma. We present three patients with recurrent neuroendocrine cervical carcinoma who experienced response to ipilimumab/nivolumab.
Neuroendocrine carcinoma of the cervix is a rare subtype of cervical cancer with a poor prognosis. Primary treatment of this disease involves a combination of surgery, chemotherapy, and radiation. The majority of patients will experience disease recurrence, for which there exist no treatment guidelines. Because of histologic similarities, small cell lung cancer has often informed management of extrapulmonary neuroendocrine carcinomas. Immunotherapy regimens, including a combination of ipilimumab and nivolumab, have been shown to have activity in small cell lung cancer. In this report, we present the cases of 3 patients with recurrent neuroendocrine carcinoma of the cervix who experienced durable response to a combination of ipilimumab and nivolumab.
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Su X, Zhou X, Xiao C, Peng W, Wang Q, Zheng Y. Complete Response to Immunotherapy Combined With Chemotherapy in a Patient With Gynecological Mixed Cancer Mainly Composed of Small Cell Neuroendocrine Carcinoma With High Tumor Mutational Burden: A Case Report. Front Oncol 2022; 12:750970. [PMID: 35795045 PMCID: PMC9251297 DOI: 10.3389/fonc.2022.750970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 05/06/2022] [Indexed: 12/01/2022] Open
Abstract
Small cell neuroendocrine carcinoma (SCNEC) is rare in the gynecologic tract, which has high invasive and metastatic ability. Due to the aggressive behavior and lack of treatment, patients have an extremely poor prognosis. Here we report a 66-year-old female diagnosed with SCNEC in the gynecologic tract, mixed with endometrioid adenocarcinoma, squamous cell, and adenosquamous carcinoma. A tumor mutational burden of 13.14 Muts/Mb was detected by next-generation sequencing. The patient underwent a palliative operation of total hysterectomy with bilateral adnexectomy but suffered from disease progression in a short time after the operation. Chemotherapy (paclitaxel + carboplatin) combined with immunotherapy (toripalimab) was conducted every 3 weeks, achieving a partial response after 2 cycles of treatment. After 5 cycles of combined treatment, the patient consolidated with monotherapy of toripalimab for about half a year and achieved a complete response. Until December 2021, the patient has achieved 27 months of progression-free survival and maintains a continued complete response. This case is presented due to the rare combination of pathological types and durable response to treatment especially immunotherapy, suggesting the potential value of immunotherapy in SCNEC of the gynecologic tract.
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Affiliation(s)
- Xingyun Su
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinhui Zhou
- Department of Gynecology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Xiao
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Peng
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiangfeng Wang
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yulong Zheng
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Yulong Zheng,
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Talia KL, Ganesan R. Neuroendocrine Neoplasia of the Female Genital Tract. Surg Pathol Clin 2022; 15:407-420. [PMID: 35715168 DOI: 10.1016/j.path.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuroendocrine neoplasia is relatively uncommon in the female genital tract (FGT) and occurs at any site, most often the ovary and cervix. A unified dichotomous nomenclature, introduced by the World Health Organization Classification of Tumors in all fifth edition volumes, divides neuroendocrine neoplasms (NENs) into well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). The term carcinoid tumor is retained in the ovary and represents the commonest FGT NEN. NEC is most common in the cervix and is usually admixed with another human papillomavirus-associated epithelial neoplasm. Despite shared neuroendocrine differentiation, NET and NEC show diverse etiology, morphology, and clinical behavior.
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Affiliation(s)
- Karen L Talia
- Department of Pathology, Royal Women's Hospital and Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia.
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham, United Kingdom
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Xu H, Zhao Z, Zhu Y. Clinicopathologic features and lymph node metastasis pattern of the cervical MiNEN. Endocrine 2022; 76:474-483. [PMID: 35102503 DOI: 10.1007/s12020-022-02992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) is a rare type of cervical tumor. Its clinicopathological features, lymph node (LN) metastatic patterns and outcomes are still unclear. METHODS We have analyzed the clinicopathological information of 26 patients with cervical MiNEN. RESULTS The median age of onset for cervical MiNEN was 48 years. Macroscopically, polyps and nodules were the main types. The neuroendocrine components included small cell neuroendocrine carcinoma (SCNEC) (14/26 cases), large cell neuroendocrine carcinoma (LCNEC) (10/26 cases), and typical carcinoid (2/26 cases). Non-neuroendocrine components included adenocarcinoma (AC) (12/26, including one case of AC in situ) and squamous cell carcinoma (SC) (10/26) and adeno-squamous cell carcinoma (ASC) (4/26). Of the 16 AC cases, 15 were human papilloma virus (HPV)-associated AC and one was HPV-independent AC. Except for the case of MiNEN with HPV-independent AC, all cases were diffusely and strongly positive for p16 protein. The lympho-vascular space invasion (LVSI) was seen in 17/26 cases, and the components that invade lymphatic vessels were mainly neuroendocrine carcinomas (NECs) (15/17), followed by SC (1/17) and AC (1/17). Ten patients developed LN metastases, including six in combined SCNECs (6/14) and four in combined LCNECs (4/10); the metastatic component was pure NEC in eight cases (8/10) and SC or AC in two cases (2/10). CONCLUSIONS NEC component is the key factor that determines the clinical behavior and prognosis of cervical MiNEN.
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Affiliation(s)
- Huihui Xu
- Department of Pathology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Zehua Zhao
- Department of Pathology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Yanmei Zhu
- Department of Pathology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.
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Neuroendocrine Neoplasms of the Gynecologic Tract. Cancers (Basel) 2022; 14:cancers14071835. [PMID: 35406607 PMCID: PMC8998008 DOI: 10.3390/cancers14071835] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 01/11/2023] Open
Abstract
Simple Summary Neuroendocrine refers to the cells that synthesize and secrete messenger chemicals such as neuropeptides and amines. Neuroendocrine neoplasms (NENs) are aggressive tumors arising from neuroendocrine cells, with an annual incidence of 6.98/100,000 and a prevalence of 170,000 in the United States. Primary gynecologic NENs constitute ≤2% of female reproductive tumors. NENs of the gynecologic tract are associated with high recurrence rates and dismal prognosis, making their treatment challenging. This article focuses on the updated staging classifications, clinicopathological characteristics, imaging, and management of NENs of the gynecological tract. Abstract Gynecological tract neuroendocrine neoplasms (NEN) are rare, aggressive tumors from endocrine cells derived from the neuroectoderm, neural crest, and endoderm. The primary gynecologic NENs constitute 2% of gynecologic malignancies, and the cervix is the most common site of NEN in the gynecologic tract. The updated WHO classification of gynecologic NEN is based on the Ki-67 index, mitotic index, and tumor characteristics such as necrosis, and brings more uniformity in the terminology of NENs like other disease sites. Imaging plays a crucial role in the staging, triaging, restaging, and surveillance of NENs. The expression of the somatostatin receptors on the surface of neuroendocrine cells forms the basis of increasing evaluation with functional imaging modalities using traditional and new tracers, including 68Ga-DOTA-Somatostatin Analog-PET/CT. Management of NENs involves a multidisciplinary approach. New targeted therapies could improve the paradigm of care for these rare malignancies. This article focuses on the updated staging classifications, clinicopathological characteristics, imaging, and management of gynecologic NENs of the cervix, ovary, endometrium, vagina, and vulva, emphasizing the relatively common cervical neuroendocrine carcinomas among these entities.
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Jiang AG, Cai X. Construction and validation of the prognostic model for patients with neuroendocrine cervical carcinoma: a competing risk nomogram analysis. BMC Cancer 2022; 22:4. [PMID: 34980030 PMCID: PMC8722105 DOI: 10.1186/s12885-021-09104-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Neuroendocrine cervical carcinoma (NECC) is an uncommon malignancy of the female reproductive system. This study aimed to evaluate cancer-specific mortality and to construct prognostic nomograms for predicting the survival of patients with NECC. Methods we assembled the patients with NECC diagnosed between 2004 to 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Meanwhile, we identified other patients with NECC from the Wenling Maternal and Child Health Care Hospital between 2002 to 2017. Fine and Gray’s test and Kaplan–Meier methods were used to evaluate cancer-specific mortality and overall survival (OS) rates, respectively. Nomograms were constructed for predicting cancer-specific survival (CSS) and OS for patients with NECC. The developed nomograms were validated both internally and externally. Results a total of 894 patients with NECC were extracted from the SEER database, then classified into the training cohort (n = 628) and the internal validation cohort (n = 266). Besides, 106 patients from the Wenling Maternal and Child Health Care Hospital served as an external validation cohort. Nomograms for predicting CSS and OS were constructed on clinical predictors. The validation of nomograms was calculated by calibration curves and concordance indexes (C-indexes). Furthermore, the developed nomograms presented higher areas under the receiver operating characteristic (ROC) curves when compared to the FIGO staging system. Conclusions we established the first competing risk nomograms to predict the survival of patients with NECC. Such a model with high predictive accuracy could be a practical tool for clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09104-9.
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Affiliation(s)
- Ai-Guo Jiang
- Department of Obstetrics and Gynecology, Wenling Maternal and Child Health Care Hospital, Wenling, Taizhou, 317500, Zhejiang province, China
| | - Xu Cai
- Department of Obstetrics and Gynecology, Wenling Maternal and Child Health Care Hospital, Wenling, Taizhou, 317500, Zhejiang province, China.
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Prodromidou A, Phelps DL, Pergialiotis V, Cunnea P, Thomakos N, Rodolakis A, Fotopoulou C, Haidopoulos D. Clinicopathological characteristics and survival outcomes of patients with large cell neuroendocrine carcinoma of the uterine cervix: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2022; 270:212-220. [DOI: 10.1016/j.ejogrb.2022.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 12/26/2022]
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Emerging Therapeutic Concepts and Latest Diagnostic Advancements Regarding Neuroendocrine Tumors of the Gynecologic Tract. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121338. [PMID: 34946283 PMCID: PMC8703600 DOI: 10.3390/medicina57121338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 12/21/2022]
Abstract
Neuroendocrine neoplasms (NENs) are particularly rare in all sites of the gynecological tract and include a variety of neoplasms with variable prognosis, dependent on histologic subtype and site of origin. Following the expert consensus proposal of the International Agency for Research on Cancer (IARC), the approach in the latest World Health Organization (WHO) Classification System of the Female Genital Tumours is to use the same terminology for NENs at all body sites. The main concept of this novel classification framework is to align it to all other body sites and make a clear distinction between well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). The previous WHO Classification System of the Female Genital Tumours featured more or less the same principle, but used the terms ‘low-grade neuroendocrine tumor’ and ‘high-grade neuroendocrine carcinoma’. Regardless of the terminology used, each of these two main categories include two distinct morphological subtypes: NETs are represented by typical and atypical carcinoid and NEC are represented by small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC). High-grade NECs, especially small cell neuroendocrine carcinoma tends to be more frequent in the uterine cervix, followed by the endometrium, while low-grade NETs usually occur in the ovary. NENs of the vulva, vagina and fallopian tube are exceptionally rare, with scattered case reports in the scientific literature.
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Yang XL, Guan WJ, Kou LN, Wang MM, Lai H, Wu DJ. A real-world, population-based study of the trends for incidence and prognosis in high-grade neuroendocrine tumor of cervix. Curr Probl Cancer 2021; 46:100800. [PMID: 34838343 DOI: 10.1016/j.currproblcancer.2021.100800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
To explore the incidence and prognosis trends for high-grade cervical neuroendocrine tumor (HGCNET) and construct a nomogram to predict prognosis for HGCNET. Annual age-adjusted incidence of HGCNET from 1975 to 2015 was retrieved from the Surveillance, Epidemiology, and End Results program, the linear regression, poisson regression and annual percentage changes were used to assess the incidence trend. Also, trends for relative survival (RS) and overall survival (OS) in HGCNET patients from 1975 to 2015 were evaluated. From 1988 to 1975, 514 HGCNET patients were selected and divided into two cohorts with a ratio of 7:3. Nomogram to predict OS for these patients was constructed and validated. The incidence trend for HGCNET was unchanged in the past four decades (P = 0.734), but the proportion of HGCNET in diagnosed cervical cancer slightly increased from 0.9% in 1975 to 1.9% in 2015 (P < 0.001). The 5-year RS and OS for HGCNET in the study periods decreased steadily (RS: P = 0.009; OS: P = 0.008). Nomogram incorporating age, T stage, lymph-node positive, distant metastasis and surgery was constructed. The C-index of the nomogram was 0.716 (0.680-0.752), which was higher than the FIGO staging system. The incidence of HGCNET remained unchanged in the past four decades but the proportion of HGCNET has slightly increased. Besides, a steadily decreasing survival for HGCNET was observed in the study periods. A nomogram was constructed to better predict prognosis for HGCNET.
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Affiliation(s)
- Xi-Lin Yang
- Department of Radiation Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wen-Ju Guan
- Department of Oncology, Chengdu Second People's Hospital, Chengdu, China
| | - Ling-Na Kou
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Ming-Ming Wang
- Department of Oncology, The first affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Hua Lai
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Da-Jun Wu
- Department of Radiation Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Walsh RJ, Tan DSP. The Role of Immunotherapy in the Treatment of Advanced Cervical Cancer: Current Status and Future Perspectives. J Clin Med 2021; 10:jcm10194523. [PMID: 34640541 PMCID: PMC8509251 DOI: 10.3390/jcm10194523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer remains one of the most common cancers in women around the world however therapeutic options in the advanced and recurrent setting are limited. Immune checkpoint inhibitors (ICI) have been considered an attractive option given the viral etiology of cervical cancer although the majority of patients do not benefit from their use. This review summarises current knowledge and use of immune checkpoint blockade in cervical cancer as well as discussing the challenges faced in their clinical application, namely, the role of biomarker-driven ICI use, potential mechanisms of resistance, strategies to overcome such resistance and additional immunotherapy options beyond ICI.
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Affiliation(s)
- Robert J. Walsh
- National University Cancer Institute, Singapore 119074, Singapore;
| | - David S. P. Tan
- National University Cancer Institute, Singapore 119074, Singapore;
- Cancer Science Institute, National University of Singapore, Singapore 117599, Singapore
- Correspondence:
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Clinicopathological Analysis of Neuroendocrine Carcinoma of the Uterine Cervix: A Single-Institution Retrospective Review of 9 Cases. Int J Surg Oncol 2021; 2021:8290659. [PMID: 34567803 PMCID: PMC8463196 DOI: 10.1155/2021/8290659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/28/2021] [Indexed: 12/05/2022] Open
Abstract
Aim To evaluate the clinicopathological features affecting the recurrence and survival of 9 cases of neuroendocrine cancer of the cervix. Method We retrospectively analyzed 9 cervical neuroendocrine cancer cases identified among 453 cervical cancer patients between 2004 and 2021 at Akdeniz University Gynecological Oncology Outpatient Clinic. Kaplan–Meier survival analysis was used for progression-free survival (PFS) and overall survival (OS). Mathematical functions of mean, standard deviation, median, Min–Max values, and frequencies were used for descriptive statistics. The categorical data were expressed in numbers and percentages (%). Results Nine patients with neuroendocrine histological subtype were selected out of 453 patients diagnosed with cervical cancer (1.98%). The average overall survival time of the patients was 26 months. The 5-year survival rate was 53.3%, while the PFS was 62.5%. The most common subtype was small cell neuroendocrine cancer. Tumours were mostly locally advanced at the time of diagnosis. 3 patients' stage was 1b2, while 4 patients were 2b, 1 patient was 3c2r, and 1 patient was 4b. All tumours showed the immunohistochemical staining properties of neuroendocrine cancer. The main treatment modality applied to our patients was surgery + adjuvant CRT. The most used chemotherapeutic agents were cisplatin/carboplatin and etoposide. Recurrence was found in 3 cases, including 5 deaths. Conclusion Neuroendocrine tumour of the cervix is a rare subtype with a poor prognosis. Unfortunately, there is not yet a standard treatment protocol due to the limited number of comparative studies of surgery, chemotherapy, and radiotherapy based treatment schemes.
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Transcription Factor Homeobox D9 Drives the Malignant Phenotype of HPV18-Positive Cervical Cancer Cells via Binding to the Viral Early Promoter. Cancers (Basel) 2021; 13:cancers13184613. [PMID: 34572841 PMCID: PMC8470817 DOI: 10.3390/cancers13184613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Transcription factor homeobox D9 (HOXD9) was previously reported to bind to the P97 promoter of HPV16 to induce viral E6/E7 oncogenes. In this article, we investigated whether HOXD9 regulated the P105 promoter of HPV18 and examined the role of HOXD9 in intracellular signaling of cervical cancer (CC). HOXD9 was directly bound to the P105 promoter and regulated the expression of E6/E7 genes of HPV18. The HOXD9 knockdown suppressed the E6/E7 gene expression in HPV18-positive cervical cancer cells. It decreased the expression of E6, activated the p53 pathway, and induced apoptosis. In addition, downregulation of the E7 gene expression activated the Rb pathway, causing G1 arrest in the cell cycle and markedly suppressing cell proliferation. Our results indicate that HOXD9 has pivotal roles in the proliferation and immortalization of HPV18-positive cervical cancer cells through activating the P105 promoter. Abstract Persistent infections with two types of human papillomaviruses (HPV), HPV16 and HPV18, are the most common cause of cervical cancer (CC). Two viral early genes, E6 and E7, are associated with tumor development, and expressions of E6 and E7 are primarily regulated by a single viral promoter: P97 in HPV16 and P105 in HPV18. We previously demonstrated that the homeobox D9 (HOXD9) transcription factor is responsible for the malignancy of HPV16-positive CC cell lines via binding to the P97 promoter. Here, we investigated whether HOXD9 is also involved in the regulation of the P105 promoter using two HPV18-positive CC cell lines, SKG-I and HeLa. Following the HOXD9 knockdown, cell viability was significantly reduced, and E6 expression was suppressed and was accompanied by increased protein levels of P53, while mRNA levels of TP53 did not change. E7 expression was also downregulated and, while mRNA levels of RB1 and E2F were unchanged, mRNA levels of E2F-target genes, MCM2 and PCNA, were decreased, which indicates that the HOXD9 knockdown downregulates E7 expression, thus leading to an inactivation of E2F and the cell-cycle arrest. Chromatin immunoprecipitation and promoter reporter assays confirmed that HOXD9 is directly associated with the P105 promoter. Collectively, our results reveal that HOXD9 drives the HPV18 early promoter activity to promote proliferation and immortalization of the CC cells.
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Mahdi H, Joehlin-Price A, Elishaev E, Dowlati A, Abbas A. Genomic analyses of high-grade neuroendocrine gynecological malignancies reveal a unique mutational landscape and therapeutic vulnerabilities. Mol Oncol 2021; 15:3545-3558. [PMID: 34245124 PMCID: PMC8637558 DOI: 10.1002/1878-0261.13057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/21/2021] [Accepted: 07/09/2021] [Indexed: 12/30/2022] Open
Abstract
High‐grade neuroendocrine carcinoma of gynecologic origin (NEC‐GYN) is a highly aggressive cancer that often affects young women. The clinical management of NEC‐GYN is typically extrapolated from its counterpart, small cell carcinoma of the lung (SCLC), but, unfortunately, available therapies have limited benefit. In our NEC‐GYN cohort, median progression‐free survival (PFS) and overall survival (OS) were 1 and 12 months, respectively, indicating the highly lethal nature of this cancer. Our comprehensive genomic analyses unveiled that NEC‐GYN harbors a higher mutational burden with distinct mutational landscapes from SCLC. We identified 14 cancer driver genes, including the most frequently altered KMT2C (100%), KNL1 (100%), NCOR2 (100%), and CCDC6 (93%) genes. Transcriptomic analysis identified several novel gene fusions; astonishingly, the MALAT1 lincRNA gene was found in ˜ 20% of all fusion events in NEC‐GYN. Furthermore, NEC‐GYN exhibited a highly immunosuppressive state, intact RB1 expression, and was uniquely enriched with the YAP1high molecular subtype. Our study identifies several potential therapeutic targets and suggests an urgent need to re‐evaluate the treatment options for NEC‐GYN.
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Affiliation(s)
- Haider Mahdi
- Gynecologic Oncology Division, Cleveland Clinic, OH, USA
| | | | - Esther Elishaev
- Department of Pathology, Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Afshin Dowlati
- Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.,University Hospitals Seidman Cancer Center, Cleveland, OH, USA.,Developmental Therapeutics Program, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ata Abbas
- Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Developmental Therapeutics Program, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Gupta P, Gupta N, Suri V, Rai B, Rajwanshi A. Cytomorphological features of cervical small cell neuroendocrine carcinoma in SurePath™ liquid-based cervical samples. Cytopathology 2021; 32:813-818. [PMID: 34241929 DOI: 10.1111/cyt.13030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/08/2021] [Accepted: 07/04/2021] [Indexed: 12/01/2022]
Abstract
Small cell neuroendocrine carcinoma (SCNEC) of the cervix is a rare, highly aggressive tumour with poor prognosis and high propensity for distant metastases. The cytological features of SCNEC have rarely been described in cervical samples, and to the best of our knowledge, there are no previous reports using SurePath™ liquid-based cytology. In the present report we present the cytomorphological features of histopathologically confirmed cases of cervical SCNEC in SurePath preparations. On cytological examination, all three cases demonstrated variable numbers of tumour cells, ranging from a few dispersed cells and tiny micro-biopsies to large aggregates of small tumour cells with a high nucleus-to-cytoplasmic ratio, stippled chromatin, inconspicuous nucleoli, and scant cytoplasm. Immunocytochemistry for CD56 on the cervical preparation confirmed the diagnosis in one case. The presence of small tumour cells with characteristic stippled/salt-and-pepper type nuclear chromatin were the most consistent cytological features in these cases. Knowledge of these characteristic cytological features can help in suggesting a diagnosis of SCNEC in cervical samples which can then be confirmed by immunocytochemistry.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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40
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Miao W, Qiuji W, Congkuan S, Yixin L, Xulong W, Boyu Z, Guizhen Q, Jun Z, Yongchang W. Small cell carcinoma as an independent prognostic factor for cervical cancer patients: a population-based analysis. Future Oncol 2021; 17:3175-3185. [PMID: 34156306 DOI: 10.2217/fon-2020-1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To compare cervical small cell carcinoma (SmCC) with squamous cell carcinoma (SCC) in patient characteristics and survival outcomes. Methods: Cervical SmCC and SCC patients in Surveillance, Epidemiology, and End Results database from 2004 to 2015 were enrolled. Propensity-score matching analysis (PSM) paired subjects with similar background variables. Cox regression, Kaplan-Meier and stratified analyses were conducted before and after PSM. Results: Cervical SmCC patients showed a higher rate of larger tumor size, advanced grade disease, lymph node involvement and distant metastasis (p < 0.001). Before and after PSM, SmCC histology and advanced Federation International of Gynecology and Obstetrics stages (p < 0.001) were principal prognostic factors of survival, and cervical SmCC was associated with worse survival in all stages (stage I-IV). Conclusion: SmCC was an independent poor prognostic factor in cervical cancer patients.
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Affiliation(s)
- Wang Miao
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Key Laboratory of Tumor Biological Behaviors Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Wu Qiuji
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Key Laboratory of Tumor Biological Behaviors Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Song Congkuan
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Liu Yixin
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Key Laboratory of Tumor Biological Behaviors Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Wang Xulong
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Key Laboratory of Tumor Biological Behaviors Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Zhang Boyu
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Key Laboratory of Tumor Biological Behaviors Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Qin Guizhen
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Key Laboratory of Tumor Biological Behaviors Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Zhang Jun
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Key Laboratory of Tumor Biological Behaviors Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Wei Yongchang
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Key Laboratory of Tumor Biological Behaviors Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
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41
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Kumar T, Nigam JS, Kumari M, Swati, Pandey J. Cervical Neuroendocrine Carcinoma: A Rare Case Report. Cureus 2021; 13:e15532. [PMID: 34269772 PMCID: PMC8266147 DOI: 10.7759/cureus.15532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/01/2022] Open
Abstract
Neuroendocrine carcinoma is a rare tumor in the uterine cervix with a dismal prognosis. Clinically, it is difficult to differentiate from other cervical malignancies. Clinical presentation varies from vaginal bleeding, discharge per vaginum and cervical mass. For better clinical outcomes, it is vital to diagnose promptly and accurately. We report a 35-year-old female presented with whitish discharge per vaginum and lower abdominal pain for six months. Per speculum reveals an irregular, firm mass measuring 4x3 cm involving both the cervical lips, which turned out to a small cell neuroendocrine carcinoma.
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Affiliation(s)
- Tarun Kumar
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Jitendra S Nigam
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Madhu Kumari
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Swati
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Jagjit Pandey
- Surgical Oncology, All India Institute of Medical Sciences, Patna, IND
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42
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Winer I, Kim C, Gehrig P. Neuroendocrine tumors of the gynecologic tract update. Gynecol Oncol 2021; 162:210-219. [PMID: 34023130 DOI: 10.1016/j.ygyno.2021.04.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
- I Winer
- Division of Gynecologic Oncology, Department of Oncology, Wayne State University, Detroit, MI, USA.
| | - C Kim
- New York Cancer Blood Specialists, Patchogue, NY, USA; Division of Hematology/Oncology, Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - P Gehrig
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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43
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Bos L, Goulder A, Prescott L, Podoll M, Frumovitz M, Brown AJ. Isolated subcutaneous recurrence of high-grade neuroendocrine tumor of the cervix. Gynecol Oncol Rep 2021; 37:100780. [PMID: 34095421 PMCID: PMC8165541 DOI: 10.1016/j.gore.2021.100780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/21/2021] [Accepted: 04/29/2021] [Indexed: 11/17/2022] Open
Abstract
•This case reports an isolated subcutaneous recurrence of neuroendocrine carcinoma of the cervix.•Multiple recurrences of NECC were treated surgically without additional systemic therapy.•There is a need for further studies to evaluate optimal treatment regimens for NECC.
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Affiliation(s)
- Lia Bos
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 1161 21st Ave. South, R-1200 Medical Center North, Nashville, TN 37232, USA
- Corresponding author.
| | - Alison Goulder
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 1161 21st Ave. South, R-1200 Medical Center North, Nashville, TN 37232, USA
| | - Lauren Prescott
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 1161 21st Ave. South, R-1200 Medical Center North, Nashville, TN 37232, USA
| | - Mirna Podoll
- Vanderbilt University Medical Center, Department of Pathology, 1161 21st Ave. South, C-3322 Medical Center North, Nashville, TN 37232, USA
| | - Michael Frumovitz
- The University of Texas MD Anderson, Department of Gynecologic Oncology , Main Building, 1515 Holcombe St., Houston, TX 77030, USA
| | - Alaina J. Brown
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 1161 21st Ave. South, R-1200 Medical Center North, Nashville, TN 37232, USA
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44
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Pei X, Xiang L, Chen W, Jiang W, Yin L, Shen X, Zhou X, Yang H. The next generation sequencing of cancer-related genes in small cell neuroendocrine carcinoma of the cervix. Gynecol Oncol 2021; 161:779-786. [PMID: 33888337 DOI: 10.1016/j.ygyno.2021.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Small cell neuroendocrine carcinoma of the cervix (SCNEC) is a lethal malignancy and little treatment progress has been made for decades. We sought to map its genetic profiles, and identify whether SCNEC harbor mutations and potential targets for therapeutic interventions. METHODS Primary tumor tissue and blood samples were obtained from 51 patients with SCNEC. The next-generation sequencing was carried out to detect mutations of 520 cancer-related genes, including the entire exon regions of 312 genes and the hotspot mutation regions of 208 genes. Quantitative multiplex PCR was performed for the detection of seven high-risk HPV types. RESULTS Of the 51 detected patients, 92.16% were positive for HPV 18. Ninety-eight percent of cases harbored genetic alterations. Two cases were observed with hypermutated phenotype and determined as MSI-H/dMMR. Genetic mutations were clustering in RTK/RAS(42.86%), PI3K-AKT(38.78%), p53 pathway(22.45%) and MYC family(20.41%). Mutations in genes involved in the p53 pathway indicate a poorer prognosis (3-year OS, 33.5% vs 59.9%, p = 0.031). A total of seven patients harboring mutations in homogeneous recombination repair (HRR) genes were reported. In addition, IRS2 and SOX2 were amplified in 14.9% and 6.12% of SCNEC patients, respectively. CONCLUSIONS SCNEC is specifically associated with HPV 18 infection. Its genetic alterations are characterized by a combined feature of high-risk HPV driven events and mutations observed in common neuroendocrine carcinoma. We identified several targetable mutated genes, including KRAS, PIK3CA, IRS2, SOX2, and HRR genes, indicating the potential efficacy of target therapies in these patients. MSI-H/dMMR individuals may benefit from checkpoint blockade therapies.
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Affiliation(s)
- Xuan Pei
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Libing Xiang
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan hospital, Fudan University, Shanghai 200032, China
| | - Wei Chen
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Obstetrics and Gynecology, Minhang Hospital, Fudan University, The Central Hospital of Minhang District, Shanghai 200032, China
| | - Wei Jiang
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lina Yin
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xuxia Shen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Pathology, Fudan university Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaoyan Zhou
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Pathology, Fudan university Shanghai Cancer Center, Shanghai 200032, China
| | - Huijuan Yang
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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45
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Caruso G, Sassu CM, Tomao F, Di Donato V, Perniola G, Fischetti M, Benedetti Panici P, Palaia I. The puzzle of gynecologic neuroendocrine carcinomas: State of the art and future directions. Crit Rev Oncol Hematol 2021; 162:103344. [PMID: 33933568 DOI: 10.1016/j.critrevonc.2021.103344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/05/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022] Open
Abstract
Primary gynecologic neuroendocrine carcinomas (gNECs) are a heterogeneous spectrum of rare and highly aggressive neoplasms, accounting for about 2% of all gynecologic malignancies, which mostly resemble the small cell lung carcinoma (SCLC). Due to the lack of standardized treatment guidelines, their management poses a noteworthy clinical challenge. Currently, cumulative data retrieved from the management of SCLC and from retrospective studies supports a multimodality strategy, based on surgery, chemotherapy, and radiotherapy. Nevertheless, the prognosis remains poor and recurrences are extremely frequent. Hence, there is an urgent need for novel treatment options and promising molecular targets. Recently, there has been an increasing interest on the potential role of immune checkpoint inhibitors, especially in the recurrent setting. However, only scant evidence exists and there is still a long road ahead. A solid collaboration between gynecologists and oncologists worldwide is required to improve the treatment of these puzzling tumors.
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Affiliation(s)
- Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy.
| | - Carolina Maria Sassu
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Federica Tomao
- Department of Gynecologic Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Margherita Fischetti
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
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46
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Kitazono I, Akahane T, Sakihama M, Yanazume S, Matsushita M, Tabata K, Kobayashi Y, Kobayashi H, Umekita Y, Tanimoto A. Human Papilloma Virus 18-Positive Submucosal Small Cell Neuroendocrine Carcinoma of the Vagina: An Immunohistochemical and Genomic Study. Int J Surg Pathol 2021; 29:870-876. [PMID: 33792412 DOI: 10.1177/10668969211007569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary vaginal neuroendocrine carcinoma (NEC) is extremely rare among female genital tract tumors. Here, we report 2 cases of vaginal small cell NEC (SCNEC) using immunohistochemistry and next-generation sequencing (NGS) analysis. The 2 patients were in their mid-to-late 70s, presented with abnormal vaginal bleeding and had a vaginal submucosal mass. The biopsied or resected tumors showed a typical neuroendocrine morphology consisting of solid nests of atypical tumor cells, with no specific organoid patterns, and proliferating in the vaginal submucosa. Immunohistochemical analysis showed strong and diffuse expression of chromogranin A, synaptophysin, and p16, but no thyroid transcription factor 1 expression. Additionally, both cases were positive for human papillomavirus (HPV) 18. An NGS-based cancer panel analysis revealed that the tumors carried NF1 and AR mutations, but no major driver mutations were detected. The results of this study suggested that HPV18 infection is linked to vaginal SCNEC.
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Affiliation(s)
- Ikumi Kitazono
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Toshiaki Akahane
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Kagoshima University Hospital, Kagoshima, Japan
| | - Mika Sakihama
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shintaro Yanazume
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Kazuhiro Tabata
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yusuke Kobayashi
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroaki Kobayashi
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Akihide Tanimoto
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Kagoshima University Hospital, Kagoshima, Japan
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47
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Cimic A, Vranic S, Arguello D, Contreras E, Gatalica Z, Swensen J. Molecular Profiling Reveals Limited Targetable Biomarkers in Neuroendocrine Carcinoma of the Cervix. Appl Immunohistochem Mol Morphol 2021; 29:299-304. [PMID: 33208671 PMCID: PMC8132903 DOI: 10.1097/pai.0000000000000884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022]
Abstract
Neuroendocrine carcinoma of the cervix (NEC) is a rare and highly aggressive cervical malignancy. Given that no targeted therapy has been approved specifically to NEC, we investigated the presence of novel, potentially targetable biomarkers in a large cohort of NEC. Sixty-two NEC were molecularly profiled for biomarkers of targeted therapies including antibody-drug conjugates [delta-like canonical notch ligand 3 (DLL3), a trophoblast cell surface antigen 2 (TROP-2), and folate receptor 1 (FOLR1)], NTRK1-3 gene fusions, and immune checkpoint inhibitors [programmed death-ligand 1 (PD-L1), tumor mutational burden, and microsatellite instability] using immunohistochemistry and DNA/RNA next-generation sequencing assays. A cohort of squamous cell carcinomas of the cervix (n=599) was used for comparison for immune-oncology biomarkers. DLL3 expression was observed in 81% of the cases. DLL3 expression was inversely correlated with commonly observed pathogenic mutations in PIK3CA (17%) (P=0.018) and PTEN (10%) (P=0.006). Other more frequently seen pathogenic mutations (TP53 17%, KRAS 11%, and CTNNB1 5%) were not associated with DLL3 expression. TROP-2 expression was detected in only 1 case and no case expressed FOLR1. Although NTRK protein expression was observed in 21% of the cases, none of these had an NTRK gene fusion. PD-L1 expression (10%) and high tumor mutational burden (3%) were significantly less frequent in NEC compared with the squamous cell carcinoma cohort (79% and 11%, respectively). None of the NEC exhibited high microsatellite instability status. Despite frequent DLL3 expression in NEC, a potential therapeutic benefit of DLL3-targeted drugs remains uncertain given the recent failure of the Rova-T therapeutic trial in small cell lung carcinomas. Small cohorts of NEC enriched in PIK3CA/PTEN/AKT and programmed cell death protein 1/PD-L1 alterations indicate therapeutic roles for their respective inhibitors.
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Affiliation(s)
- Adela Cimic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | | | - Zoran Gatalica
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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48
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Comparative Analysis of Genetic Alterations, HPV-Status, and PD-L1 Expression in Neuroendocrine Carcinomas of the Cervix. Cancers (Basel) 2021; 13:cancers13061215. [PMID: 33802174 PMCID: PMC8001835 DOI: 10.3390/cancers13061215] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Patients with neuroendocrine carcinoma of the cervix (NECC) have limited treatment options due to its rarity and aggressiveness. In this study, we performed a comparative genetic analysis between 25 NECC and other cervical cancer types (180 squamous cell carcinoma, 53 adenocarcinoma, and 14 adenosquamous carcinoma). Furthermore, the expression of programmed cell death-ligand 1 (PD-L1) was assessed by immunohistochemistry. PIK3CA and TP53 were commonly altered genes in cervical cancer, while SMAD4, RET, EGFR, and APC were NECC-specific altered genes. Of note, 11 NECC cases showed at least one actionable mutation linked to molecular targeted therapies, and 14 cases showed more than one combined positive score for PD-L1 expression. These results may boost the generation of effective treatment strategies for NECC in the future. Abstract Neuroendocrine carcinoma of the cervix (NECC) is a rare and highly aggressive tumor with no efficient treatment. We examined genetic features of NECC and identified potential therapeutic targets. A total of 272 patients with cervical cancer (25 NECC, 180 squamous cell carcinoma, 53 adenocarcinoma, and 14 adenosquamous carcinoma) were enrolled. Somatic hotspot mutations in 50 cancer-related genes were detected using the Ion AmpliSeq Cancer Hotspot Panel v2. Human papillomavirus (HPV)-positivity was examined by polymerase chain reaction (PCR)-based testing and in situ hybridization assays. Programmed cell death-ligand 1 (PD-L1) expression was examined using immunohistochemistry. Somatic mutation data for 320 cases of cervical cancer from the Project GENIE database were also analyzed. NECC showed similar (PIK3CA, 32%; TP53, 24%) and distinct (SMAD4, 20%; RET, 16%; EGFR, 12%; APC, 12%) alterations compared with other histological types. The GENIE cohort had similar profiles and RB1 mutations in 27.6% of NECC cases. Eleven (44%) cases had at least one actionable mutation linked to molecular targeted therapies and 14 (56%) cases showed more than one combined positive score for PD-L1 expression. HPV-positivity was observed in all NECC cases with a predominance of HPV-18. We report specific gene mutation profiles for NECC, which can provide a basis for the development of novel therapeutic strategies.
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Randall LM, Walker AJ, Jia AY, Miller DT, Zamarin D. Expanding Our Impact in Cervical Cancer Treatment: Novel Immunotherapies, Radiation Innovations, and Consideration of Rare Histologies. Am Soc Clin Oncol Educ Book 2021; 41:252-263. [PMID: 34010052 DOI: 10.1200/edbk_320411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cervical cancer is a socially and scientifically distinguishable disease. Its pathogenesis, sexual transmission of high-risk HPV to a metaplastic portion of the uterine cervix, makes cervical cancer preventable by safe and effective HPV vaccines commercially available since 2006. Despite this, cervical cancer remains the deadliest gynecologic cancer in the world. Regrettably, global incidence and mortality rates disproportionately affect populations where women are marginalized, where HIV infection is endemic, and where access to preventive vaccination and screening for preinvasive disease are limited. In the United States, cervical cancer incidence has gradually declined over the last 25 years, but mortality rates remain both constant and disparately higher among communities of color because of the adverse roles that racism and poverty play in outcome. Until these conditions improve and widespread prevention is possible, treatment innovations are warranted. The last standard-of-care treatment changes occurred in 1999 for locally advanced disease and in 2014 for metastatic and recurrent disease. The viral and immunologic nature of HPV-induced cervical cancer creates opportunities for both radiation and immunotherapy to improve outcomes. With the advent of T cell-directed therapy, immune checkpoint inhibition, and techniques to increase the therapeutic window of radiation treatment, an overdue wave of innovation is currently emerging in cervical cancer treatment. The purpose of this review is to describe the contemporary developmental therapeutic landscape for cervical cancer that applies to most tumors and to discuss notable rare histologic subtypes that will not be adequately addressed with these treatment innovations.
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Affiliation(s)
- Leslie M Randall
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | - Amanda J Walker
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Angela Y Jia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Devin T Miller
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | - Dmitriy Zamarin
- Department of Medicine, Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Weill-Cornell Medical College, New York, NY
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Uccella S, La Rosa S, Metovic J, Marchiori D, Scoazec JY, Volante M, Mete O, Papotti M. Genomics of High-Grade Neuroendocrine Neoplasms: Well-Differentiated Neuroendocrine Tumor with High-Grade Features (G3 NET) and Neuroendocrine Carcinomas (NEC) of Various Anatomic Sites. Endocr Pathol 2021; 32:192-210. [PMID: 33433884 DOI: 10.1007/s12022-020-09660-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
High-grade neuroendocrine neoplasms (HG-NENs) are clinically aggressive diseases, the classification of which has recently been redefined. They now include both poorly differentiated NENs (neuroendocrine carcinoma, NECs) and high proliferating well-differentiated NENs (called grade 3 neuroendocrine tumors, G3 NETs, in the digestive system). In the last decade, the "molecular revolution" that has affected all fields of medical oncology has also shed light in the understanding of HG NENs heterogeneity and has provided new diagnostic and therapeutic tools, useful in the management of these malignancies. Considering the kaleidoscopic aspects of HG NENs in various anatomical sites, this review systematically addresses the genomic landscape of such neoplasm throughout the more common thoracic and digestive locations, as well as it will consider other rare but not exceptional primary sites, including the skin, the head and neck, and the urogenital system. The revision of the available literature will then be oriented to understand the translational relevance of molecular data, by analyzing conceptual issues, clinicopathological correlations, and unmet needs in this field.
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Affiliation(s)
- Silvia Uccella
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Stefano La Rosa
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jasna Metovic
- Department of Oncology, University of Turin, Torino, Italy
| | - Deborah Marchiori
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Jean-Yves Scoazec
- Department of Pathology, Gustave Roussy Cancer Campus, Paris, France
| | - Marco Volante
- Department of Oncology, University of Turin, Torino, Italy
| | - Ozgur Mete
- Department of Pathology, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mauro Papotti
- Department of Oncology, University of Turin, Torino, Italy
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