PMC5458407_01
Cytological findings from the uterine cervical smear. (a) Cluster of small cells with high nuclear/cytoplasmic ratios or lacking cytoplasm was observed. Nuclei of small cell neuroendocrine carcinoma show hyperchromatic, finely stippled nuclear features and an Indian file pattern. (b) Both adenocarcinoma (white arrow) and small cell neuroendocrine carcinoma (black arrow) cells were observed in the proteinaceous debris-filled background (c) Adenocarcinoma showing a gland-like pattern. Tumor cells showed abundant cytoplasm, unevenly distributed large nuclei, and ground glass chromatin (Pap, a and c: x1000; b: x400)
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F1
Smear cytology of the uterine cervix revealed distinct atypical cells in a proteinaceous debris-filled background with no streaming artifacts [Figure 1a]. The majority of the tumor cells were found to be of relatively smaller size than adenocarcinoma cells; these smaller cells presented predominantly as hyperchromatic crowded clusters with numerous single cells [Figure 1b]. In contrast, tumor cells possessing unevenly distributed larger nuclei were observed admixed with SCNEC cells and were arranged in a tight, glandular-like pattern [Figure 1c].
Histologic findings of uterine cervical carcinoma. (a) Small cell neuroendocrine carcinoma was present in some adenocarcinomatous components, showing a tubular pattern (H and E). Surrounding tubular structures and individual tumor cells were small and showed a high nuclear/cytoplasmic ratio and round or elliptical nuclei with nuclear molding. (b-e) Immunohistochemistry demonstrating the expression of various molecular markers. (b) Cervical adenocarcinoma exhibiting diffuse cytoplasmic staining for cytokeratin 19. (c and d) Small cell neuroendocrine carcinoma exhibiting diffuse cytoplasmic staining for CD56 and synaptophysin, respectively. (e) Both small cell neuroendocrine carcinoma and adenocarcinoma exhibiting diffuse, strongly cytoplasmic, and nuclear staining with p16 (a-e, x200)
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F2
Histologically, the tumor was comprised two adjacent components of almost equal area, containing either small-sized or moderately sized cells [Figure 2a]. Immunohistochemically, areas showing a tubular pattern were positive for cytokeratin (CK) 19 [Figure 2b]. We found that the specimen was strongly positive for synaptophysin and CD56 in areas harboring smaller cells [Figure 2c and d], with no observable staining for chromogranin A (data not shown). In both tumor areas, mitotic figures were frequently observed, and almost all tumor cells were intensely stained immunohistochemically with p16 [Figure 2e].