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Yamagata Med J（ISSN 0288-030X）2021；39
須藤，榊，奥井，鈴木，清野，太田，永瀬
（1）
：65-70
DOI 10.15022/00004898
Co-existing small-cell neuroendocrine carcinoma, adenoid
cystic carcinoma, and squamous cell carcinoma of cervical cancer:
a case report
Takeshi Sudo, Hirotsugu Sakaki, Yosuke Okui, Yuriko Suzuki,
Manabu Seino, Tsuyoshi Ota, Satoru Nagase
Department of Obstetrics and Gynecology, Yamagata University, Faculty of Medicine
ABSTRACT
Although there have been several reports of mixed cervical cancer with two histological types,
cases of mixed cancer with three histological types are extremely rare. We report a case of mixed
cervical cancer with three histological types. A 67-year-old woman（4 gravida, 3 para）consulted
a previous doctor with a chief complaint of irregular genital bleeding. Small-cell carcinoma was
suspected based on the cervical cytology, and she was referred to our hospital. No gross lesion in the
cervix was observed on vaginal speculum examination. She was diagnosed with small-cell carcinoma
of the uterine cervix based on a cervical biopsy. No parauterine tissue infiltration was observed on
pelvic examination. Magnetic resonance imaging showed a tumorous lesion in the cervix that was
20 mm in size and showed high signal intensity on T2-weighted images. No distant metastasis was
found on imaging, and abdominal radical hysterectomy and bilateral salpingo-oophorectomy were
performed based on a diagnosis of stage IB1 cervical cancer. Microscopically, small atypical cells with
high nuclear–cytoplasmic ratios proliferated solidly in the cervical lesion, and cluster of differentiation
（CD）56, synaptophysin, and neuron-specific enolase tested partially positive on immunostaining. In
addition, some basal cell-like tumor cells showed infiltration and proliferation while forming large and
small alveolar nests and tested positive for α-smooth muscle actin, CD10, and p63 on immunostaining.
Furthermore, squamous cell carcinoma, which is a poorly differentiated component accompanied by
keratinization, was also detected. The interstitial invasion of the uterine cervix was 2/3 or greater,
but neither lymphatic or vascular invasion nor pelvic lymph node metastasis was found. Collectively,
the diagnosis was stage IB1（pT1bN0M0）cervical cancer with a mixed histology of small-cell
neuroendocrine carcinoma, adenoid cystic carcinoma, and squamous cell carcinoma. The patient was
administered adjuvant chemotherapy including etoposide/cisplatin because she was categorized in
the middle-risk group of recurrence. She had no evidence of disease for more than 1 year after the
surgery.
Keywords: cervical cancer, small cell carcinoma, adenoid cystic carcinoma, mixed cancer
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