Exfoliative cytology of large cell neuroendocrine carcinoma of the uterine cervix

In the uterine cervix, tumors with neuroendocrine differentiation are rare.1 Neuroendocrine tumors have been classified into four categories: small cell, large cell, classic carcinoid and atypical carcinoid.2,3 The most common neuroendocrine tumors are small cell carcinomas. Large cell neuroendocrine carcinomas are much less common than the small cell type.1-3 The cytologic features of cervical small cell carcinoma have been well described.4,5 However, the cytologic findings of cervical large cell neuroendocrine carcinomas have not been previously reported. A 57-year-old woman presented with abnormal vaginal bleeding for two months. She had undergone subtotal hysterectomy due to a myoma 7 years earlier. Physical examination revealed an irregular margin at the transitional junction. Cervical smear and biopsy were performed. The patient underwent radical trachelectomy with bilateral pelvic lymphadenectomy. The tumor was staged according to the Federation of Gynecology and Obstetrics criteria as IIB. The patient was scheduled to receive postoperative radiotherapy. She developed lesions metastatic to the lung and left flank 2 years and 5 months after surgery and died of the tumor 3 years and 5 months after the surgery. The cervical smear showed hyperchromatic, crowded cellular groups (Figure 1). The nuclei of the tumor cells were ovoid, and the diameters were 3-5 times larger than those of small lymphocytes. Two or more prominent nucleoli were present. Nuclear pleomorphism was not marked. The nuclei contained coarsely clumped chromatin (Figure 2). The tumor cells had moderate to abundant cytoplasm