Linage plasticity in a synchronous combined tumor of neuroendocrine carcinoma and adenocarcinoma of uterine cervix

Neuroendocrine carcinoma (NEC) of small cell type (SCNEC) of the uterine cervix is a high-grade variant of neuroendocrine carcinoma according to the WHO classification of tumors of female reproductive organs (4th edition). Most of the cancer of the uterine cervix are classified into two histologies; squamous cell (70%) and adenocarcinoma (AdCa) (25%), meanwhile SCNEC, also called small cell carcinoma, is a rare cancer, representing about 1-2% of all cervical cancers. SCNEC is frequently accompanied with AdCa or squamous cell carcinoma. To date, the mechanistic detail regarding the mixed tumor phenotype is not well clarified. Here, we performed single cell RNA sequencing (Nx1-seq) of the mixed tumor cultured by CTOS method to show the existence of cells which are able to bidirectionally differentiate, and investigated molecular mechanisms underlying the differentiation status.