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Background <p>Small cell neuroendocrine carcinoma of the cervix (SCNCC) is a rare, aggressive malignancy accounting for 1–3% of cervical cancers. Its occurrence during pregnancy is exceptionally uncommon, with fewer than 20 cases described in the literature. SCNCC is characterized by rapid progression, early lymphovascular spread, and poor prognosis, posing unique diagnostic and therapeutic challenges when encountered in pregnancy.</p> Case <p>We report a case of a 31-year-old primigravida who presented at 21&#xa0;weeks of gestation with painless vaginal bleeding. Clinical examination revealed a friable cervical mass replacing the cervix and filling the vaginal canal. MRI demonstrated an 8.6 × 9.0 × 7.0&#xa0;cm mass with bilateral parametrial invasion and pelvic lymphadenopathy. Cervical biopsy confirmed SCNCC with a Ki-67 index of 95%, immunopositive for synaptophysin, p16, and INSM1. The disease was staged as FIGO IIIC1(r). A multidisciplinary tumor board recommended chemoradiation, and the patient elected termination of pregnancy to enable timely treatment. Termination was performed by hysterotomy, and two weeks later she commenced external beam radiotherapy with concurrent cisplatin and etoposide. At three months, PET-CT confirmed complete resolution of disease, and she remains disease-free at 2.5&#xa0;years of follow-up.</p> Conclusion <p>Pregnancy-associated SCNCC is exceedingly rare and requires individualized, multidisciplinary management. Early recognition of non-obstetric causes of bleeding in pregnancy is critical. Aggressive multimodal therapy with platinum–etoposide chemoradiation remains the cornerstone of treatment, and durable remission, though uncommon, is achievable. This case adds to the limited literature and underscores the importance of collaborative management in optimizing maternal outcomes.</p>

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Small-Cell Neuroendocrine Carcinoma of the Cervix at 21 Weeks of Gestation: Multidisciplinary Management and Outcomes

  • 期刊论文

  • 发表日期：

    2025年12月11日

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  • Saroj Rajan,
  • Swati Tomar,
  • Chandrima Ray,
  • Sushmita Pathy,
  • Sachin Khurana,
  • Smita Manchanda,
  • Sandeep Mathur,
  • Neerja Bhatla,
  • Neena Malhotra,
  • Seema Singhal

摘要

Background

Small cell neuroendocrine carcinoma of the cervix (SCNCC) is a rare, aggressive malignancy accounting for 1–3% of cervical cancers. Its occurrence during pregnancy is exceptionally uncommon, with fewer than 20 cases described in the literature. SCNCC is characterized by rapid progression, early lymphovascular spread, and poor prognosis, posing unique diagnostic and therapeutic challenges when encountered in pregnancy.

Case

We report a case of a 31-year-old primigravida who presented at 21 weeks of gestation with painless vaginal bleeding. Clinical examination revealed a friable cervical mass replacing the cervix and filling the vaginal canal. MRI demonstrated an 8.6 × 9.0 × 7.0 cm mass with bilateral parametrial invasion and pelvic lymphadenopathy. Cervical biopsy confirmed SCNCC with a Ki-67 index of 95%, immunopositive for synaptophysin, p16, and INSM1. The disease was staged as FIGO IIIC1(r). A multidisciplinary tumor board recommended chemoradiation, and the patient elected termination of pregnancy to enable timely treatment. Termination was performed by hysterotomy, and two weeks later she commenced external beam radiotherapy with concurrent cisplatin and etoposide. At three months, PET-CT confirmed complete resolution of disease, and she remains disease-free at 2.5 years of follow-up.

Conclusion

Pregnancy-associated SCNCC is exceedingly rare and requires individualized, multidisciplinary management. Early recognition of non-obstetric causes of bleeding in pregnancy is critical. Aggressive multimodal therapy with platinum–etoposide chemoradiation remains the cornerstone of treatment, and durable remission, though uncommon, is achievable. This case adds to the limited literature and underscores the importance of collaborative management in optimizing maternal outcomes.