Dados do Trabalho

Título

NEUROENDOCRINE CARCINOMA OF THE UTERINE CERVIX WITH LEPTOMENINGE CARCINOMATOSES: A RARE CASE REPORT

Apresentação do caso

E.C.B, latin american, female, 45 years old at diagnosis, housewife, born and resident in São Paulo-SP. No personal history, G2P2A0, menarche at 12 years old, non-smoker.The patient presented with metrorrhagia and pelvic pain for 10 months. Sought care at a Gynecology service where a biopsy compatible with neuroendocrine carcinoma of the uterine cervix and immunohistochemistry was performed, showing positivity for chromogranin, synaptophysin, enolase and p16; p53 with non-aberrant pattern and positive Ki-67 100% of cells.She underwent Abdomen Resonance and Chest Tomography, being staged as FIGO IIb (T2bN0M0).
She performed four cycles of Chemotherapy with Cisplatin and Etoposide concomitantly with Radiotherapy (total dose: 4500 cGy) and then performed Brachytherapy, ending the treatment in March 2021, MRI showed a complete local response.After four months, the patient presented with clinical worsening, complaining of severe headache associated with progressive vertigo, nausea and vomiting. Appropriate investigation was carried out: CT scan showed intra-axial nodular lesion and leptomeningeal thickening, and Neuroaxis MRI showed signs of intracranial hypertension, posterior fossa metastasis and leptomeningeal thickening. Liquoric cytology expressed 2% of atypical cellularity.She evolves with neurological worsening and after ten days of the initial symptoms she dies.

Discussão

Neuroendocrine cervical cancer was first described in 1957. It is considered rare and represents about 2% of cervical malignancy.The average age at diagnosis is 45 years, and association with HPV is increasingly being related.

Comentários finais

Neuroendocrine carcinoma is prone to distant metastases, similar to small cell lung carcinoma. The organs most commonly involved are the liver, adrenals, bone and central nervous system, with diagnosis being common in more advanced stages. Central nervous system (CNS) metastases occurs by hematogenous dissemination. CNS metastases are uncommon, with few cases described in the literature. In the present report, the initial progression took place within a period of two months, with tropism for the central nervous system and leptomeninges, demonstrating the rare and aggressive behavior of the neoplasm, requiring prospective studies for early recognition and greater therapeutic approaches of this rare neoplasia.

Palavras-chave

Neuroendocrine cervical cancer, Leptomeninge carcinomatoses, cervical cancer