SCIENTIFIC
Neuroendocrine Tumor of the Gynecological Tract : A Case Report of High-Grade Neuroendocrine Carcinoma of the Endometrium
AUTHORS :
Sydney Graham , MPH Medical Student , Joan C . Edwards School of Medicine , Marshall University
Lindsay Bias , APRN Nurse Practitioner , Department of Oncology , Edwards Comprehensive Cancer Center
Niru Nahar , MD Assistant Professor , Department of Pathology , Cabell Huntington Hospital Laboratory
Nadim Bou Zgheib , MD Associate Professor , Director of Gynecologic Oncology , Department of Oncology , Edwards Comprehensive Cancer Center
CASE PRESENTATION
A 71-year-old woman with a past medical history of congestive heart failure , hypertension , Type 2 diabetes mellitus , hyperlipidemia , hypothyroidism , and gastroesophageal reflux disease presented to her gynecologist with postmenopausal bleeding for 1 week . She underwent an endo metrial biopsy , which revealed high-grade , poorly differentiated carcinoma . She was referred to gynecological oncology and underwent a robotic-assisted total laparoscopic hysterectomy , bilateral salpin gooophorectomy , complete pelvic tumor debulking , bilateral pelvic lymph node dissection , and infracolic omentectomy . On gross examination , the uterus weighed 111.2 g and measured 8.4 x 7.5 x 4.6 cm . A pink to gray-white friable mass was predominately present in the posterior wall and fundus of the uterus and extended through the myometrium to serosa and attached omentum . The mass infiltrated bilateral parametria , omentum , and vasculature of the myometrium . Bilateral ovaries , bilateral fallopian tubes , and cervix were spared . Six pelvic lymph nodes were dissected , none of which were positive for metastasis . Her final diagnosis was Federation of Gynecology and Obstetrics ( FIGO ) stage 4B high-grade neuroendocrine carcinoma ( more than 90 %) arising in association with endometrioid carcinoma , FIGO
ABSTRACT
Neuroendocrine tumors ( NETs ) of the gynecological tract are rare and aggressive tumors with no standardized management protocol . This group can be classified based on location of origin , morphologic features , and prognosis . In addition , NETs of the endometrium can co-occur with non-NET endometrial carcinoma . Our case concerns a 71-year-old female
grade 3 , with focal sarcomatoid features ( less than 10 %), supported by immunohistochemical stains ( Figure 1 and 2 ).
The neuroendocrine carcinoma component of the mass stained diffusely positive for pancytokeratin , synaptophysin , and CD56 and predominately expressed p16 and p53 . The endometroid carcinoma component of the mass stained diffusely positive for pancytokeratin , cytokeratin 7 , estrogen receptor , vimentin , epithelial membrane antigen , and cadherin . Additionally , the endometroid carcinoma com ponent of the mass did not stain for neuroendocrine markers , including synaptophysin and CD56 . Microsatellite instability ( MSI ) screening demonstrated intact expression of MSH2 , MSH6 , MLH1 , and PMS2 .
FIGURE 1
who was diagnosed with high-grade neuroendocrine carcinoma arising in conjunction with endometroid carcinoma with focal sarcomatoid features . We provide a succinct review of the literature in order to emphasize the development , diagnosis , management , and prognosis of NET of the endometrium .
Postoperatively , the patient ’ s hospital course was complicated by postoperative ileus and hyperkalemia , which required electrolyte replacement therapy . The patient was discharged on postoperative day 3 and scheduled for telemedicine follow-up due to the distance between her home and the cancer center . At the follow-up visit , the diagnosis was disclosed with the recommendation of adjuvant chemotherapy , including 6 cycles of cisplatin and etoposide , and radiation therapy . The patient chose to receive care at a facility closer to her home . Per outside records , the patient received carboplatin and etoposide chemotherapy regimen , as she was not a candidate for cisplatin therapy and refused radiation therapy . She did not tolerate chemotherapy well due to comorbidities , and soon after the initial diagnosis , she experienced bilateral hydrone
Figure 1 : Hematoxylin and Eosin ( H & E ) stained microscopic pictures of carcinoma : 1A ) Adenocarcinoma ( yellow arrow ) and neuroendocrine carcinoma ( black arrow ), 1B ) Diffuse proliferation of neuroendocrine carcinoma in myometrium with multiple areas of lymphovascular invasion ( black arrows ), 1C ) High power image , several mitotic cells of neuroendocrine carcinoma ( yellow arrows )
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