Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Int J Surg Pathol. 2024 Aug;32(5):920-925. doi: 10.1177/10668969231208029. Epub 2023 Oct 30.
Preoperative neoadjuvant therapy followed by resection is the mainstay treatment for locally advanced esophageal adenocarcinoma. We recently observed the histology shift from predominant esophageal adenocarcinoma in the biopsy to neuroendocrine neoplasm with or without adenocarcinoma in the post-treatment resection. The underlying mechanism of this finding is uncertain, and there is limited information in the literature. A total of 11 patients were identified: 10 patients received presurgical chemoradiation and 1 with chemotherapy. All biopsies were diagnosed with adenocarcinoma. When neuroendocrine immunomarkers were retrospectively performed on 5 biopsies, 2 showed focal positivity, although the classic neuroendocrine morphology was not readily appreciated. All resections contained neuroendocrine neoplasm, including 8 of well-differentiated type and 3 of neuroendocrine carcinomas. Two post-treatment esophagectomies consisted of neuroendocrine neoplasm only without residual adenocarcinoma. Upon follow-up, 8 patients died of the disease (median survival = 26 months), and 3 patients were alive after a median follow-up of 14 months. The overall median survival time was better than the reported esophageal neuroendocrine carcinoma (15 months). The 5-year observed survival rate was 11.3%, which was lower than the Surveillance, Epidemiology, and End Results 5-year survival rate of adenocarcinoma (21.8%). We reported a small series of esophageal adenocarcinoma that showed histology shift between biopsy and esophagectomy after neoadjuvant therapy. Our limited data suggest that prognosis of this group is different than the conventional adenocarcinoma. Awareness of this morphological change reminds pathologists to examine the biopsy specimens thoroughly, because recognition of neuroendocrine neoplasm, especially high-grade neuroendocrine component, might potentially affect pre- and post-surgical regimens.
术前新辅助治疗后再行切除术是局部晚期食管腺癌的主要治疗方法。我们最近观察到，活检中的主要组织学类型从食管腺癌转变为治疗后切除标本中的神经内分泌肿瘤伴或不伴腺癌。这种现象的潜在机制尚不清楚，文献中相关信息有限。共发现 11 例患者：10 例接受术前放化疗，1 例接受化疗。所有活检均诊断为腺癌。对 5 例活检标本进行神经内分泌免疫标志物回顾性检测时，2 例显示局灶性阳性，尽管经典的神经内分泌形态学不易观察到。所有切除标本均包含神经内分泌肿瘤，其中 8 例为高分化型，3 例为神经内分泌癌。2 例治疗后食管切除术仅包含神经内分泌肿瘤，无残留腺癌。随访时，8 例患者死于该疾病（中位生存时间=26 个月），3 例患者在中位随访 14 个月后仍存活。总体中位生存时间优于报道的食管神经内分泌癌（15 个月）。5 年观察生存率为 11.3%，低于 Surveillance, Epidemiology, and End Results（监测、流行病学和最终结果）登记处腺癌的 5 年生存率（21.8%）。我们报告了一小系列食管腺癌患者，这些患者在新辅助治疗后活检和食管切除术中出现组织学转变。我们的数据有限，表明该组的预后与传统腺癌不同。认识到这种形态学变化提醒病理学家仔细检查活检标本，因为识别神经内分泌肿瘤，特别是高级别神经内分泌成分，可能会影响术前和术后的治疗方案。
