Peculiarities of the rare histopathological types of invasive cervical cancer – A three-year experience at a regional cancer institute

Objectives: More than 90% of carcinoma cervix comprises squamous cell carcinoma and usual type adenocarcinoma, while rare histopathological variants constitute <5% of cases and pose diagnostic and therapeutic challenges. Material and Methods: We retrospectively reviewed patients with uncommon histotypes of invasive cervical cancer treated at our institute between September 2019 and September 2022. Cases of squamous cell carcinoma, usual-type adenocarcinoma, and adenosquamous carcinoma were excluded. Clinical features, imaging, management, histopathology, immunohistochemistry (IHC), and outcomes were analyzed. Results: Twelve patients were identified, with a median age of 40 years (range: 21–72). Histologies included neuroendocrine carcinoma (n=3), malignant melanoma (n=3), clear cell carcinoma (n=2), adenosarcoma (n=1), basaloid squamous cell carcinoma (n=1), lymphoma (n=1), and leiomyosarcoma (n=1). Postmenopausal bleeding was the most common presentation. Hyperpigmentation of the cervix was seen in all the cases of malignant melanoma. A pre-operative accurate diagnosis was made in 83.33% cases (10 out of 12). 2 cases of neuroendocrine carcinoma received neoadjuvant chemotherapy. In 4 cases, radical hysterectomy type C1 was done. IHC was essential but often showed overlapping features; only clear cell carcinoma was consistently human papillomavirus (HPV) independent. At the last follow-up, six patients remained asymptomatic. Conclusion: Rare cervical cancer histotypes are heterogeneous, diagnostically challenging, and often associated with poor outcomes. Histopathology supplemented by IHC remains central to diagnosis. Management should be individualized, as no standardized protocols exist. Larger multicentric studies are required to optimize treatment strategies.