Mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) of the cervix in a 38-year-old female: a case report and review of literature

• Post-coital bleeding with prolapsed cervical myoma led to surgery. • Biphasic tumor morphology identified and confirmed by immunohistochemistry. • Rapid lymph node and brain metastases within nine months despite chemotherapy. Mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) in the cervix constitutes <1 % of all gynecological malignancies. Despite its rarity, they are highly aggressive often presenting with early nodal metastasis and distant metastasis and have poor prognosis. Due to its limited incidence, early recognition with prompt diagnosis and early therapeutic intervention are of utmost importance. Here, we present a case of a 38-year old female with episodes of post-coital spotting. Microscopically, two different populations of tumor cells were appreciated − the first is composed of sheets of fairly uniform small cells with hyperchromatic nuclei, indistinct nuclear contour and scant cytoplasm and the second consists of infiltrating glands with enlarged, ovoid, hyperchromatic nuclei with coarse chromatin and ample eosinophilic cytoplasm. Immunohistochemistry studies were done showing positivity for Chromogranin, Synaptophysin, and p16, while CEA highlighted the glandular component, hence the diagnosis of Mixed Neuroendocrine and Non-Neuroendocrine Carcinoma (Small Cell Carcinoma and HPV-Associated Type Adenocarcinoma) was made. Due to its poor prognosis, clinical, imaging, and histopathologic correlation as well as prudent utilization of immunohistochemical stains are vital in arriving at a diagnosis and initiation of treatment. Currently, there is no standard therapeutic approach for MiNEN and as a result, multimodal treatment strategies are employed to enhance survival outcomes.