A Rare Case of Esophageal Neuroendocrine Carcinoma Arising on an Endoscopic Resection Scar

Aims Neuroendocrine carcinoma (NEC) of the esophagus is an extremely aggressive and rare cancer, with a reported incidence of less than 2 % of the esophageal cancers.

Methods

Results A 61-year-old woman with gastroesophageal reflux disease underwent esophagogastroduodenoscopy (EGD) due to worsening of epigastric pain. EGD revealed a 10mm flat lesion on the middle third of the esophagus and biopsies demonstrated high grade dysplasia. The patient was referred to our hospital and was submitted to curative endoscopic submucosal dissection (ESD) of the esophageal lesion (high-grade dysplasia, free margins). The patient was submitted to follow-up EGD at 6 and 12 months, that showed a regular scar. Seven months after the last follow-up, the patient presented with chest pain and dysphagia. EGD revealed an ulcero-vegetating tumor with 3cm at the same location of previous ESD. After histological and immunostaining analysis, biopsies showed a poorly differentiated small cell NEC (positivity for synaptophysin; Ki67>80 %). Subsequent computed tomography supported EGD esophageal findings and identified peri-tumor and hilar adenophaties, and an extensive periceliac nodal conglomerate adherent to the liver. The patient was presented at a multidisciplinary meeting where palliative radiochemotherapy was planned.

Conclusions The existence of esophageal NEC with components of adenocarcinoma or squamous cell carcinoma is well established. In this case, the first lesion was curatively resected and consisted only of high-grade dysplasia. This does not support the association between the two lesions, and histopathology revision of the ESD specimen confirmed the absence of neuroendocrine proliferation in the initial lesion. This clinical case highlights the rapidly progressive and aggressiveness of this lesion, and reminds us that alarm symptoms should trigger additional investigation even if there is a recent EGD. This is, to our knowledge, the first case described of esophageal NEC arising on the endoscopic resection scar.

Citation: Ortigão R, Pita I, Marques Sá I et al. eP28 A RARE CASE OF ESOPHAGEAL NEUROENDOCRINE CARCINOMA ARISING ON AN ENDOSCOPIC RESECTION SCAR. Endoscopy 2021; 53: S106.

Publication History

Article published online:
19 March 2021