Neuroendocrine Malignancies of the Cervix: What Radiologists Need to Know

Neuroendocrine malignancies of the cervix (NEM) are an aggressive tumor with early metastasis and recurrence, resulting in poor prognosis and 5-year mortality ranging from 10% to 25% for later stages of disease. These are a rare malignancy of middle-aged and elderly women with an incidence of <2%. The clinical presentation is like the common cervical cancer-squamous cell carcinoma, presenting with nonspecific vaginal bleeding. Pap smear has very low sensitivity and accuracy for NEM, leading to delayed diagnosis. Due to its low incidence, the lack of specific clinical findings, and the limited sensitivity of Pap smears for diagnosing NEM, delays in diagnosis are common, contributing to a higher number of late-stage presentations. Hence, diagnosis by imaging using features such as intratumoral necrosis and hemorrhage, lower ADC values with a cutoff of 0.9×10 -3  mm 2 /s, lymphadenopathy, parametrial and vascular invasion, infiltrative features, and pathologic sampling with immunohistochemical staining is crucial and of paramount importance. We aim to discuss the clinical, imaging, and pathologic findings of NEM and describe the current management options for patients with this aggressive malignancy.