Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

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David Rain
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Vaginal Small Cell Neuroendocrine Carcinoma: A Case Report

Tohar Lev*, Electra Korn, Lisa Turri, Nicholas Tarricone

Department of OBGYN, Mount Sinai South Nassau, Oceanside, NY

Abstract: We report a case of small cell neuroendocrine carcinoma of the vagina treated with primary resection with positive margins and subsequent chemoradiation. This rare case highlights the importance of a thorough gynecologic exam, full evaluation for any and all abnormal findings, and a comprehensive care team.

Keywords: Vaginal tumor, small cell carcinoma, vaginal mass

Received August 01, 2024; Revised September 01, 2024; Accepted September 08, 2024

Citation: Tohar Lev, Electra Korn, Lisa Turri, Nicholas Tarricone, Vaginal Small Cell Neuroendocrine Carcinoma: A Case Report. American Journal of Medical Case Reports, 12 (8). 127-130. January 2024. doi:10.12691/ajmcr-12-8-6

1. Introduction

Vaginal neuroendocrine tumors, including both small and large cell forms, are rare, with limited understanding of risk factors and treatment recommendations. There is also limited evidence for how to evaluate disease burden and response to treatment, although fluoro-2-deoxy-D- glucose (FDG) PET/CT scans have demonstrated efficacy for detecting lymph node involvement or other spread of disease, as well as to detect local recurrence or response to treatment. Disease outcomes are poor, as the tumors tend to be aggressive with early spread and poor response to treatment. We report a case of small cell neuroendocrine carcinoma of the vagina treated with primary resection with positive margins and subsequent chemoradiation. We explore the importance of thorough gynecologic exam, full evaluation for any and all abnormal findings, and a comprehensive care team.

2. Case Report

Patient is a 34yo G0 with history of HPV-negative atypical squamous cells of uncertain significance (ASCUS), fibroids, primary ovarian insufficiency, obesity, and hypertension presented to her primary gynecologist for abnormal uterine bleeding. Exam at the time was unremarkable and the patient opted to return if a second episode occurred. She returned 6 months later for a second abnormal cycle. Further workup was performed including repeat Pap smear, which was significant for high-risk HPV-positive atypical squamous cells, cannot exclude high grade squamous epithelial lesion (ASC-H). Colposcopy and endocervical biopsy were performed and within normal limits. She was recommended to undergo LEEP at this time but deferred. No lesion was noted at either of those visits or procedures.

She followed up 1 year after her initial visit for secondary amenorrhea. On physical examination at that time, there was noted to be a soft, ballotable lesion arising from the right lateral vaginal sidewall, concerning for a Gartner’s duct cyst. She subsequently underwent hysteroscopy, dilation and curettage (D&C), loop electrosurgical excision procedure (LEEP), and excision of vaginal lesion the following month. Pathology of the LEEP demonstrated scant detached atypical cells and squamous metaplasia. D&C pathology demonstrated endometrial polyps with proliferative endometrium and a benign endocervix.

Figure 1. Multiple FDG avid enlarged lynmph nodes are seen in the right iliac and lower retroperitoneal lymph nodes

At surgery, the approximately 3cm lesion was noted to be firmer and pedunculated arising from the lateral vaginal right fornix adjacent to the junction of the cervix at 10 o’clock. It was resected at its base and felt as though it was removed en toto. Pathology of the vaginal lesion demonstrated high-grade neuroendocrine tumor with carcinoma extending to the biopsy margins. Immunostains demonstrated positive CD56, chromogranin, synaptophysin, and PCK. Stains for CK20, HMB45, and S-100 were negative. PET-CT performed the same month demonstrated fluorodeoxyglucose (FDG) avid enlarged right iliac and lower retroperitoneal lymph nodes consistent with lymph node metastases. No FDG avid distant disease was noted (Figure 1 and Figure 2).

Figure 2. (A) CT showing mass in vagina

Patient was referred to oncology specialists at a tertiary care center including gynecologic oncology, medical oncology, and radiation oncology.

Figure 3. (A) 3/6/2023 Body FDG PET/CT: Resolved FDG avid retroperitoneal and pelvic nodal metastases. No new FDG avid metastatic disease seen. (B). No suspicious uptake in the vagina

Patient was diagnosed with stage IIIc2 small cell carcinoma of the vagina, which was determined to not be amenable to surgical resection. She was treated with chemoradiotherapy starting 14 months after her initial visit. Treatment included 25 treatments with external beam radiation, as well as high-dose rate interstitial brachytherapy with 4 fractions (2400cGY). She underwent 5 cycles of cisplatin/etoposide. At this time, 19 months after her first visit and 6 months after initial resection, she was noted to have non-avid PET-CT consistent with successful treatment (Figure 3 and Figure 4).

Figure 4. (A) 3/6/2023 MRI of pelvis- no mass in cervix or vagina. (B) Decreased and resolved pelvic nodes

3. Discussion

Historically, gynecologic small cell neuroendocrine carcinoma is a rare form of cancer with poor survival rates of approximately 15% at 1 year after diagnosis, with median time to relapse of 8 months from initial treatment in older studies [1]. In a 2004 review of 21 cases, no patients with lymph node metastases survived [2]. Vaginal cases remain one of the least common forms of this disease [3]. Although additional isolated cases have been studied over the subsequent decades, treatments continue to vary widely with poor survival rates [4,5]. Most evidence comes from treatment of the more prevalent small cell cancer of the lung.

This case initially presented as a typical, uncomplicated ASC-H for which the algorithm for SIL (Squamous Intraepethelial Lesion) was followed. As it turns out, the ASC-H was in reality a result of the evolution of small cell neuroendocrine tumor as patient’s colposcopy, LEEP, and endocervical curettage were negative for SIL/CIN.

This case highlights the importance of a thorough gynecologic exam. A gynecologic exams should be a full evaluation for any and all abnormal findings, not merely a pap smear. All abnormal findings should be appropriately evaluated and biopsied with proper consideration for surgical planning and referred to the appropriate tertiary/quartenary care experts upon diagnosis.

Certain considerations should be taken for surgical planning in unique cases such as these. Firstly, surgery

should be done under ideal conditions with adequate anesthesia to facilitate a complete exam and resection. This case was done under MAC sedatation at an ambulatory surgery center with access to a tertiary care hospital if needed.

Futhermore, when unusual findings are noted such as change in the character of the lesion initially diagnosed (Gartner’s duct cyst) to a more ominous pre-op appearance, there should be higher index for suspicion for unusual pathology and surgical planning should change accordingly. Although this lesion was excised at its base, there was a subcentimeter margin. Perhaps consideration should have been taken for a wider margin approaching two centimeters. Certainly we would not advocate perfomring a PET scan for everyone with ASC-H pap, albeit for a patient with a rare finding perhaps pre-op workup with imaging may be considered.

In order for the patient to receive comprehensive care, it is important for referalls to be given to tertiary or quarternary care centers in rare cases such as these due to lack of experience of even the most experienced gynecologist oncologist.

Our patient is still relatively early in her treatment course after initial local resection, but has thus far been successfully treated with cisplatin, etoposide, external beam radiation, and interstitial brachytherapy. These results are consistent with existing evidence that small cell gynecologic tumors should be treated with etoposide combined with a platinum-based agent, regardless of disease stage [6].

In the setting of negative evidence of disease within 5 months of diagnosis, patient will continue to require close follow-up to evaluate for recurrence. We hope that aggressive early management and close follow-up with PET-CT with FDG avidity will allow for longer progression-free survival.

Fertility preservation is an important consideration for young oncology patients and should be discussed. Our patient desired to preserve fertility. She chose to undergo oocyte retrieval prior to initiating chemoradiation therapy but did not have adequate retrieval. As a sequale of these events, patient was subsequently diagnosed with depression. She was referred to psychotherapy which was successful.

References

[1]   | Kaminski J. M., Andersen P. M., Han A. C., et al. Primary small cell carcinoma of the vagina. Gynecologic Oncology. 2003; 88(3): 451–455.
[2]   | Viswanathan A. N., Deavers M. T., Jhingran A., Ramirez P. T., Levenback C., Eifel P. J. Small cell neuroendocrine carcinoma of the cervix: outcome and patterns of recurrence. Gynecologic Oncology. 2004; 93(1): 27–33.
[3]   | atta G, van der Zwan JM, Casali PG, Siesling S, Dei Tos AP, Kunkler I, Otter R, Licitra L, Mallone S, Tavilla A, Trama A, Capocaccia R; RARECARE working group. Rare cancers are not so rare: the rare cancer burden in Europe. Eur J Cancer. 2011 Nov; 47(17): 2493-511.
[4]   | Kostamo K, Peart M, McKenzie N, Holloman C, Carlan SJ, Ge L, Maksem J. Novel Treatment of Small-Cell Neuroendocrine of the Vagina. Case Rep Oncol Med. 2018 Feb 4; 2018: 9157036.
[5]   | Frumovitz M., Munsell M. F., Burzawa J. K., et al. Combination therapy with topotecan, paclitaxel, and bevacizumab improves progression-free survival in recurrent small cell neuroendocrine carcinoma of the cervix. Gynecologic Oncology. 2017; 144(1): 46–50.
[6]   | Cohen JG, Chan JK, Kapp DS. The management of small-cell carcinomas of the gynecologic tract. Curr Opin Oncol. 2012 Sep; 24(5): 572-9.