PMC6676253_01
(a) Sagittal T2-weighted MRI revealed a cervical tumor growing mainly from the posterior uterine cervix (asterisk). (b) Front view of the nodular cervical tumor with a longitudinal incision of the anterior uterine wall (postoperative photo, white arrow).
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Magnetic resonance imaging (Figure 1(a)) and contrast-enhanced computed tomography showed that the tumor was confined to the cervix, and they indicated enlargement of intra-pelvic lymph nodes without evidence of nodal involvement, and no distant metastasis. We performed a radical hysterectomy with the fetus in situ, a bilateral salpingo-oophorectomy, and pelvic and paraaortic lymphadenectomy at 18 weeks of gestation (Figure 1(b)).
(a) The tumor, with a high nuclear-cytoplasmic ratio, was growing in diffuse sheets, showing a rosette in some parts. Extensive necrosis was present. (b) The tumor consisted of dense sheets of small cells with scant cytoplasm, finely granular nuclear choromatin, frequent mitoses. Nucleoli are inconspicuous or absent. Nuclear molding was present. (c) HE stain at the same magnification ratio as the immunostains. (d) Immunostaining showed the absence of chromogranin A, but the presence of (e) synaptophysin and (f) neural cell adhesion molecule.
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A cervical biopsy was performed and the specimen was stained with hematoxylin-eosin (HE): the small-size cells of the tumor had a high nuclear-cytoplasmic ratio, finely granular nuclear choromatin, nuclear molding, and absent or inconspicuous nucleoli, suggesting SCCC (Figure 2(a)-(c)). Immunostains revealed the absence of chromogranin A (Figure 2(d)) but the presence of synaptophysin (Figure 2(e)) and neural cell adhesion molecule (Figure 2(f)), supporting the diagnosis of SCCC.