Korean J Gastroenterol.  2016 Nov;68(5):265-269. 10.4166/kjg.2016.68.5.265.

A Case of Endoscopically Complete Remission of Esophageal Neuroendocrine Tumors by Concurrent Chemoradiation Therapy

• Kim MH
• Jeong HY
• Seong JK
• Moon HS
• Kang SH
• Kim DK

• KMID: 2383504
• DOI: http://doi.org/10.4166/kjg.2016.68.5.265

Abstract

Neuroendocrine tumors (NETs) of the esophagus are extremely rare, aggressive and have a poor prognosis. Combined therapy using chemotherapy, radiotherapy and/or surgery appear effective. Here, we present a patient with a complaint of dysphagia who was diagnosed with this rare tumor. Upper gastrointestinal endoscope of a 46-year-old female revealed a localized ulcerative lesion in the middle esophagus. Histologic exam of biopsy specimens indicated a neuroendocrine carcinoma. The tumor cells were arranged in microtubular structures, with small and round cells containing scanty cytoplasm. They were positive for synaptophysin and chromogranin A on immunohistochemical staining. A computed tomography scan showed an esophageal tumor with enlarged superior mediastinal lymph nodes and about 1.2 cm sized liver metastasis, similar to findings in PET-CT scanning. The patient was prescribed chemotherapy consisting of etoposide and cisplatin, which led to regression of disease on follow-up imaging study. She continues under clinical observation. We seek to increase awareness of this exceedingly rare but hazardous disease by sharing our unexpected finding.

Keyword

Neuroendocrine tumors; Endoscopy; Esophageal neoplasms

MeSH Terms

Biopsy
Carcinoma, Neuroendocrine
Chromogranin A
Cisplatin
Cytoplasm
Deglutition Disorders
Drug Therapy
Endoscopes, Gastrointestinal
Endoscopy
Esophageal Neoplasms
Esophagus
Etoposide
Female
Follow-Up Studies
Humans
Liver
Lymph Nodes
Middle Aged
Neoplasm Metastasis
Neuroendocrine Tumors*
Prognosis
Radiotherapy
Synaptophysin
Ulcer
Chromogranin A
Cisplatin
Etoposide
Synaptophysin

Figure

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  Fig. 1. (A) Upper gastrointestinal endoscopy revealed a localized ulcerative lesion in the esophagus. (B) The primary tumor of the esophagus diminished after chemotherapy and concurrent chemoradiation therapy.

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  Fig. 2. Microscopic findings (×200). (A) Cytology H&E; (B) synap-tophysin; (C) chromogranin A.

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  Fig. 3. A computed tomography scan showed (A) enlarged superior mediastinal lymph nodes (white arrow) of (B) an esophageal tumor (black arrow) with (C) a ∼1.2-cm-sized hypoattenuated lesion (arrowhead) in S5 of the liver.

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  Fig. 4. A computed tomography scan showed (A) the primary tumor (white arrow) at the esophagus, (B) a metastatic tumor (black arrow) in the lymph node, and (C) S5 of the liver diminished in size (arrowhead) after chemotherapy and concurrent chemoradiation therapy.

Reference

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