# Case Report: Diagnostic challenges in cervical small cell neuroendocrine carcinoma of a reproductive-age woman

## TL;DR

A 36-year-old woman with a rare cervical cancer faced diagnostic delays and poor outcomes despite treatment, highlighting the challenges in managing this aggressive disease.

## Contribution

This case report emphasizes the diagnostic difficulties and rapid progression of cervical small cell neuroendocrine carcinoma in a young patient.

## Key findings

- SCNEC was diagnosed at an advanced stage despite prior negative biopsies and atypical cytology results.
- The patient's disease progressed rapidly despite platinum-based chemotherapy and immunotherapy.
- The case resulted in death from multiorgan failure due to extensive metastases.

## Abstract

Small cell neuroendocrine carcinoma of the cervix (SCNEC) is a rare and highly aggressive malignancy with a poor prognosis. We report the case of a 36-year-old nulliparous woman with a history of HPV-18 infection and repeated cytology showing atypical squamous cells of undetermined significance (ASC-US), while multiple biopsies remained negative. She initially underwent surgery for multiple uterine leiomyomas and severe endometriosis. Ten months later, she presented with acute pelvic pain, rectal pressure, and minor vaginal bleeding. Combined hysteroscopy and laparoscopy revealed suspicious lesions, and histopathology with immunohistochemistry confirmed International Federation of Gynecology and Obstetrics (FIGO) stage IVB SCNEC. Postoperatively, she received platinum-based chemotherapy followed by salvage immunotherapy. Despite a transient decline in tumor markers, the disease progressed rapidly, with enlargement and confluence of pelvic lesions and extensive bone metastases, ultimately resulting in death from multiorgan failure. This case highlights the diagnostic challenges, early systemic dissemination, and poor outcomes of SCNEC, underscoring the urgent need for more effective therapeutic strategies.