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DOI: 10.1055/a-1682-7012
Endoscopic submucosal dissection for an early-stage neuroendocrine carcinoma composited with squamous cell dysplasia
Supported by: Research and Development Fund of Zhongshan Hospital Affiliated to Fudan University 2019ZSFZ28Supported by: Clinical Research Fund of Zhongshan Hospital Affiliated to Fudan University 2020ZXLC33
Supported by: Science and Technology Commission of Shanghai Municipality http://dx.doi.org/10.13039/501100003399 19ZR1409600
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A 51-year-old man complained of dysphagia for 2 months. A reddish and rough lesion was found 25 cm from the incisor under esophagogastroduodenoscopy (EGD) ([Fig. 1 a]). Pathological assessment of the biopsy indicated neuroendocrine carcinoma ([Fig. 1 b]). The patient was an alcohol addict. Pre-operative examination revealed pancytopenia and portal hypertension with collateral development ([Fig. 1 c]). Positron emission tomography/computed tomography (PET/CT) excluded distal metastasis. Considering the high risk of bleeding and leakage for esophagectomy, endoscopic treatment was suggested after multi-disciplinary discussion. The lesion was resected with endoscopic submucosal dissection (ESD) ([Fig.1 d, e]). Iodine staining indicated an unstained area in part of the gross specimen. Final diagnosis was collision carcinoma, neuroendocrine carcinoma combined with squamous cell high grade intraepithelial neoplasm (HGIN) ([Fig. 1 f, g]). The tumor was confined to the mucosal muscularis layer, without lymphovascular invasion. The lateral and horizontal margins were both negative. The patient declined further chemotherapy and received active surveillance. No recurrence or metastasis was detected 18 months after ESD ([Fig. 1 h, i]) ([Video 1]).
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Video 1 Endoscopic submucosal dissection for an early-stage neuroendocrine carcinoma composited with squamous cell dysplasia.
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Esophageal neuroendocrine carcinoma is a rare disease characterized by high malignancy. Patients usually present with distant metastasis at diagnosis [1] [2]. Histological diagnosis of neuroendocrine carcinoma by biopsy is difficult for it generally presents as a submucosal tumor covered by non-neoplastic epithelium [2]. On the other hand, neuroendocrine carcinomas sometimes have mixed components of squamous and/or glandular cells, which often lead to misdiagnosis [3]. The standard management of esophageal neuroendocrine carcinomas has not yet been established owing to the paucity of available data. Radical esophagectomy should be considered as the primary treatment for stage I/IIA patients [4]. Whether radiochemotherapy is necessary for early-stage esophageal neuroendocrine carcinoma remains controversial. Until now, only few cases of esophageal neuroendocrine carcinoma treated by ESD instead of surgery have been reported [2] [5]. ESD provides an alternative for patients at high risk of surgical complications. However, whether ESD is equally effective compared with traditional radical surgery for superficial esophageal neuroendocrine carcinoma is still uncertain. Further evidence with more cases and longer follow-up are warranted for this specific problem.
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Publication History
Article published online:
21 December 2021
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References
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- 3 Watanabe K, Hikichi T, Sato M. et al. A case of endocrine cell carcinoma combined with squamous cell carcinoma of the esophagus resected by endoscopic submucosal dissection. Fukushima J Med Sci 2014; 60: 187-191
- 4 Xu L, Li Y, Liu X. et al. Treatment strategies and prognostic factors of limited-stage primary small cell carcinoma of the esophagus. J Thorac Oncol 2017; 12: 1834-1844
- 5 Ishikawa KakiyaY, Nagami Y, Fujiwara Y. Intramucosal esophageal neuroendocrine carcinoma treated with endoscopic submucosal dissection and chemotherapy. Dig Endosc 2019; 31: 466