Fujihara Shintaro, Kobayashi Masahiko, Nishi Masako, Yachida Tatsuo, Yoshitake Akira, Deguchi Akihiro, Muraoka Atsushi, Kobara Hideki, Masaki Tsutomu
Department of Gastroenterology, Kagawa Rosai Hospital, 3-3-1, Joutou, Marugame, Kagawa, Japan.
Department of Surgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan.
J Med Case Rep. 2018 Aug 24;12(1):227. doi: 10.1186/s13256-018-1775-z.
Neuroendocrine cell carcinoma is a rare variant of esophageal carcinoma. The characteristic clinical features and diagnosis of superficial neuroendocrine cell carcinoma remain to be established. We report a rare case of superficial coexistence of neuroendocrine cell carcinoma with squamous cell carcinoma treated by endoscopic submucosal dissection, and regional lymph node metastasis was detected after additional surgical treatment.
A 77-year-old Japanese man with esophageal squamous cell carcinoma received endoscopic submucosal dissection in en-bloc resection. Histopathological findings showed that lymphovascular invasion by the neuroendocrine cell carcinoma component occurred in the deep part of the muscularis mucosa. Regional lymph node metastasis was identified after additional surgical treatment. After surgical treatment, our patient received chemotherapy consisting of etoposide and carboplatin for 3 months. He is alive and shows no sign of disease recurrence 12 months after surgery.
This case report highlights the fact that even if neuroendocrine cell carcinoma is small and limited to superficial, the tumor has the potential for metastasis if lymphovascular invasion by the neuroendocrine cell carcinoma component occurs. In addition, this case indicates the necessity of close follow-up of small neuroendocrine cell carcinoma after treatment.
神经内分泌细胞癌是食管癌的一种罕见变异类型。浅表性神经内分泌细胞癌的特征性临床特征及诊断方法仍有待确定。我们报告了1例罕见的经内镜黏膜下剥离术治疗的神经内分泌细胞癌与鳞状细胞癌浅表共存病例，并在后续手术治疗后检测到区域淋巴结转移。
一名77岁的日本男性食管鳞状细胞癌患者接受了内镜黏膜下剥离术整块切除。组织病理学检查结果显示，神经内分泌细胞癌成分的淋巴管浸润发生在黏膜肌层深部。后续手术治疗后发现区域淋巴结转移。手术治疗后，患者接受了依托泊苷和顺铂联合化疗3个月。术后12个月，他仍然存活，且无疾病复发迹象。
本病例报告强调了这样一个事实，即即使神经内分泌细胞癌较小且局限于浅表，如果发生神经内分泌细胞癌成分的淋巴管浸润，肿瘤仍有转移的可能。此外，该病例表明治疗后对小神经内分泌细胞癌进行密切随访的必要性。
