A 31-year-old woman presents with abnormal uterine bleeding. Biopsy of a firm, barrel-shaped cervix shows sheets of small round blue cells with scant cytoplasm, nuclear moulding and numerous mitoses. Immunohistochemistry shows synaptophysin positivity. Which statement about this tumour is correct?
- A It behaves indolently and is managed like a low-grade endometrioid neoplasm
- B It has a strong association with HPV 18 and is treated with platinum plus etoposide combined with radiation ✓
- C It carries an excellent prognosis when confined to the cervix and needs only conisation
- D It is almost always HPV negative and arises from reserve cells of the transformation zone
Correct answer: B. It has a strong association with HPV 18 and is treated with platinum plus etoposide combined with radiation
Explanation
The description is primary small cell neuroendocrine carcinoma of the cervix. It is strongly linked to HPV 18, follows an aggressive course with early haematogenous and nodal spread, and is managed on the lines of pulmonary small cell carcinoma using cisplatin/carboplatin with etoposide alongside locoregional therapy. Conisation alone is inadequate even for small tumours because occult metastasis is common.
Reference: Berek and Novak's Gynecology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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