Cutaneous metastases from neuroendocrine carcinoma of the cervix-An unusual metastatic lesion from an uncommon malignancy

Neuroendocrine carcinoma (NEC) is an uncommon and aggressive type of small cell cervical cancer. NECs mostly arise from gastro-entero-pancreatic tract and the lung, but rarely from other organs like cervix. NEC of the cervix is a rare malignancy and constitutes 0.9%-1.5% of cervical tumors. NECs of cervix are common in perimenopausal females and present with abnormal vaginal bleeding and mimic squamous cell cancers, usually with no distinguishing features. On Immunohistochemistry, presence of chromogranin, synaptophysin, and CD-56 is necessary to make a diagnosis of small cell carcinoma. These tumors are notorious for local as well as distant relapses in comparison to their squamous and adenocarcinoma counterpart. NECs are characterized by highly aggressive clinical behavior and carry a poor prognosis. They commonly metastases to lung, liver, brain, and bones even in early stages of the disease. Metastasis to skin is a rare occurrence. We herein report a case of a NEC of the uterine cervix with multiple cutaneous metastases. After the initial diagnosis of NEC of cervix, the patient received concurrent chemoradiation followed by intracavitary brachytherapy. On subsequent follow-up, the patient developed multiple cutaneous metastasis along with liver metastases. This case is reported in view of rarity of the case with skin metastases. To the best of our knowledge, only 3 cases of cutaneous metastases from NEC of the cervix are reported till date. Being a rare malignancy, evidence in the literature is in form of case reports and small case series. Thus, the optimal treatment strategy varies for these patients. Multimodality management with teamwork is necessary to manage individual patients. (C) 2018 Elsevier Inc. All rights reserved.