Barrett's Esophageal Adenocarcinoma with Neuroendocrine Cell Carcinoma Treated by Endoscopic Submucosal Dissection: A Case Report and Literature Review.

Barrett's esophageal adenocarcinoma (BEA) with neuroendocrine cell carcinoma (NEC) is a rare disease with a poor prognosis. We report a case of BEA with NEC treated by endoscopic submucosal dissection (ESD) with en bloc resection and long-term survival was achieved without additional treatment. An 84-year-old man underwent an upper gastrointestinal endoscopy, which revealed an erythematous lesion within a short-segment Barrett's esophagus (BE) at the esophagogastric junction. A diagnosis of well-differentiated tubular adenocarcinoma (tub1) was made after biopsy, specifically, BEA (EG, Type 0-IIa, 15 mm, cT1a), and ESD was performed. Histopathological findings showed differentiated adenocarcinoma in Barrett's esophageal mucosa background, with 20% of all tumors having NEC components. The final diagnosis was adenocarcinoma (tub1>tub2) with focal neuroendocrine cell carcinoma in BE, EG, Type 0-IIa, 13 × 9 mm, pT1a-DMM, ly0, v0 pHM0, pVM0. Considering the patient's advanced age and wishes, we decided to follow up without any additional treatment. The patient has survived 52 months after ESD without metastatic recurrence. Even if histopathological findings after ESD reveal BEA with NEC and en bloc resection, careful follow-up is necessary because of the high risk of recurrence.