伴HSIL及AIS的混合型宫颈神经内分泌癌复发进展一例报告

A Case Report of Recurrence and Progression of Mixed-Type Neuroendocrine Carcinoma of the Cervix with HSIL and AIS

摘要: 宫颈神经内分泌癌(Neuroendocrine Carcinoma of the Cervix, NECC)是一种罕见且高度侵袭性的宫颈恶性肿瘤，易发生早期复发及远处转移。尽管近年来其诊疗策略不断优化，但总体预后仍不理想。既往研究提示，伴有混合组织学成分的NECC可能具有不同的生物学行为及预后特征，但相关证据仍有限。本文报道1例伴混合组织学成分的宫颈神经内分泌癌患者。初始病理提示NECC合并高级别鳞状上皮内病变(High-grade Squamous Intraepithelial Lesion, HSIL)及宫颈原位腺癌(Adenocarcinoma in Situ, AIS)。患者接受根治性手术治疗，术后未行进一步全身综合治疗。随访约1年后出现局部复发，继而进展为伴淋巴结转移的宫颈小细胞神经内分泌癌。本病例显示，混合组织学成分的NECC仍具有较强侵袭性，其复发及进展过程具有一定临床特征。该病例为进一步认识此类肿瘤的生物学行为提供了临床依据，同时提示在局部治疗基础上联合全身多模式治疗对于改善预后具有重要意义。

Abstract: Neuroendocrine carcinoma of the cervix (NECC) is a rare but highly aggressive malignancy characterized by a high risk of early recurrence and distant metastasis. Despite advances in diagnostic and therapeutic strategies, the overall prognosis remains poor. Previous studies have suggested that NECC with mixed histological components may exhibit distinct biological behavior and potentially different prognostic outcomes; however, evidence remains limited due to its rarity. Herein, we report a case of NECC with mixed histological components. The initial pathological findings revealed NECC coexisting with high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS). The patient underwent radical surgery but did not receive subsequent systemic multimodal therapy. Approximately one year later, local recurrence was detected, followed by progression to small cell neuroendocrine carcinoma of the cervix with lymph node metastasis. This case demonstrates that NECC with mixed histological features may still exhibit highly aggressive behavior. The observed pattern of recurrence and progression provides real-world clinical insights into the biological behavior of this rare entity. Furthermore, it underscores the potential importance of systemic multimodal therapy following definitive local treatment to improve patient outcomes.