Kaneko Yuki, Saito Shin, Takahashi Kazuya, Kanamaru Rihito, Hosoya Yoshinori, Yamaguchi Hironori, Kitayama Joji, Niki Toshiro, Lefor Alan Kawarai, Sata Naohiro
Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Department of Clinical Oncology, Jichi Medical University, Shimotsuke, Japan.
Clin J Gastroenterol. 2019 Dec;12(6):534-538. doi: 10.1007/s12328-019-00995-7. Epub 2019 May 27.
A 68-year-old male was referred with dysphagia. Endoscopic findings showed circular stenosis with a protruding mass in the lower esophagus. Biopsy showed adenocarcinoma and there was no evidence of distant metastases. A subtotal esophagectomy was performed. The resected specimen revealed a mixed neuroendocrine carcinoma with adenocarcinoma. The adenocarcinoma component was on the surface of the tumor and the neuroendocrine component invaded the deeper portion. Immunohistochemically, the neuroendocrine carcinoma component stained positive for cytokeratin 7 and cytokeratin 20, suggesting that the neuroendocrine carcinoma originated from the adenocarcinoma. The adenocarcinoma component stained positive for MUC2, which suggests that the adenocarcinoma component originated from Barrett's epithelium. Taken together, the neuroendocrine carcinoma may have originated from Barrett's epithelium. A metastasis to the liver was found 2 months after the surgical resection. Chemotherapy was administered, but there was no response. Most esophageal neuroendocrine carcinomas are accompanied by adenocarcinoma or squamous cell components, suggesting that these carcinomas originate from pluripotent cells in squamous or Barrett's epithelium. Appropriate chemotherapy for these lesions should be considered based on the cell of origin.
一名68岁男性因吞咽困难前来就诊。内镜检查发现食管下段有环形狭窄并伴有突出肿物。活检显示为腺癌，且无远处转移证据。遂行食管次全切除术。切除标本显示为混合性神经内分泌癌伴腺癌。腺癌成分位于肿瘤表面，神经内分泌成分侵犯更深层。免疫组化显示，神经内分泌癌成分细胞角蛋白7和细胞角蛋白20染色阳性，提示神经内分泌癌起源于腺癌。腺癌成分MUC2染色阳性，提示腺癌成分起源于巴雷特上皮。综合来看，神经内分泌癌可能起源于巴雷特上皮。手术切除2个月后发现肝转移。给予化疗，但无反应。大多数食管神经内分泌癌伴有腺癌或鳞状细胞成分，提示这些癌起源于鳞状上皮或巴雷特上皮中的多能细胞。应根据起源细胞考虑对这些病变进行适当化疗。
