Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3164-3169
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3164
Endoscopic submucosal dissection combined with adjuvant chemotherapy for early-stage neuroendocrine carcinoma of the esophagus: A case report
Nan Tang, Zhen Feng
Nan Tang, Zhen Feng, Department of Gastroenterology, Shanghai Xuhui Center Hospital, Shanghai 200031, China
Author contributions: Tang N followed the patient and drafted the manuscript; Feng Z checked the data; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen Feng, Doctor, MD, Chief Physician, Department of Gastroenterology, Shanghai Xuhui Center Hospital, No. 966 Middle Huaihai Road, Shanghai 200031, China. fengzhen1903@hotmail.com
Received: July 17, 2021
Peer-review started: July 17, 2021
First decision: October 16, 2021
Revised: October 25, 2021
Accepted: February 22, 2022
Article in press: February 22, 2022
Published online: April 6, 2022
Processing time: 255 Days and 2.6 Hours
Abstract
BACKGROUND

Neuroendocrine carcinoma (NEC) of the esophagus is rare and highly aggressive, and lacks biological features. Currently, there are no established standard treatments for this cancer. In this report, we describe a patient with large-cell NEC of the esophagus who was successfully treated using endoscopic submucosal dissection (ESD) combined with adjuvant chemotherapy.

CASE SUMMARY

A 55-year-old woman presented with intermittent mild dysphagia for 2 mo. Gastroscopy revealed a disc-shaped protruding lesion about 18 mm × 18 mm in size on the upper esophagus. Endoscopic ultrasonography demonstrated that the bulged lesion originated from the muscularis mucosa. We assessed en bloc resections using ESD for therapeutic diagnosis to devise a safe and appropriate treatment. Histopathological examination revealed a poorly differentiated neoplasm comprising of large cells with marked nuclear atypia and multifocal necrosis. In addition, the specimens had a negative horizontal margin and vertical margins. Depth of invasion was classified as submucosa 2 (SM2) without lymphovascular invasion. These histopathological results were consistent with a diagnosis of esophageal NEC, large cell type. Adjuvant therapy has been considered for ESD patients with SM2/SM3 lesions and patients with poorly differentiated lesions. After comprehensive consideration, we initiated combination treatment, i.e., ESD plus adjuvant chemotherapy. The patient remained disease-free at the 2-year follow-up.

CONCLUSION

En bloc resection approach using ESD may play a vital role as a diagnostic and therapeutic modality for esophageal NEC.

Keywords: Esophagus; Neuroendocrine carcinoma; Endoscopy; Dissection; Case report

Core Tip: We describe a patient with large-cell neuroendocrine carcinoma (NEC) of the esophagus who was successfully treated using endoscopic submucosal dissection (ESD) combined with adjuvant chemotherapy. No standard treatment strategies are available for esophageal NEC due to a lack of clinical studies and its rarity. En bloc resection approach using ESD may play a vital role as a diagnostic and therapeutic modality for esophageal NEC.