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Lania A, Ferraù F, Rubino M, Modica R, Colao A, Faggiano A. Neoadjuvant Therapy for Neuroendocrine Neoplasms: Recent Progresses and Future Approaches. Front Endocrinol (Lausanne) 2021; 12:651438. [PMID: 34381421 PMCID: PMC8350565 DOI: 10.3389/fendo.2021.651438] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors, their treatment being challenging and requiring a multidisciplinary approach. Though the only curative treatment is surgery, up to 50% of patients are diagnosed with metastatic disease. In the last years, neoadjuvant chemo(radio)therapy has become part of the standard of care in the treatment of different cancer types. However, evidence of its efficacy and safety in NEN patients has not yet been confirmed in the literature. The aim of the present review is to perform an extensive review of the scientific evidence for neoadjuvant therapy in patients with gastroenteropancreatic and thoracic NENs.
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Affiliation(s)
- Andrea Lania
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center—IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
- *Correspondence: Andrea Lania,
| | - Francesco Ferraù
- Department of Human Pathology of Adulthood and Childhood ‘G. Barresi’, University of Messina, Messina, Italy
- Endocrine Unit, University Hospital G. Martino, Messina, Italy
| | - Manila Rubino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | - Roberta Modica
- Endocrinology, Department of Clinical Medicine and Surgery, “Federico II” University of Napoli, Napoli, Italy
| | - Annamaria Colao
- Endocrinology, Department of Clinical Medicine and Surgery, “Federico II” University of Napoli, Napoli, Italy
| | - Antongiulio Faggiano
- Endocrinology, Department of Experimental Medicine, “Sapienza”, University of Rome, Rome, Italy
- Department of Experimental Medicine, Division of Medical Physiopathology, Sapienza University of Rome, Rome, Italy
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Giannetta E, Guarnotta V, Rota F, de Cicco F, Grillo F, Colao A, Faggiano A. A rare rarity: Neuroendocrine tumor of the esophagus. Crit Rev Oncol Hematol 2019; 137:92-107. [PMID: 31014519 DOI: 10.1016/j.critrevonc.2019.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/08/2018] [Accepted: 02/26/2019] [Indexed: 01/09/2023] Open
Abstract
Esophageal Neuroendocrine tumors (NETs) are rare, aggressive and lacking specific symptoms. This causes a diagnostic delay, worsening the prognosis. Numerous cases are reported in literature, without a consensus on the management. Our aim was to clarify epidemiology, clinical presentation, diagnostic, therapeutic management of esophageal NETs. Extensive literature search identified a total of 226 articles. One hundred twenty-five articles (n = 1676) met the inclusion criteria, showing that: the incidence of esophageal NET varies geographically; men (60-70 years) are more affected; smoking and alcohol abuse are the major risk factors; dysphagia, weight loss, appetite loss are the most common clinical features. The histotypes include high-grade small and large cell esophageal carcinomas and low-grade carcinoid tumors. Mixed neuroendocrine/non-neuroendocrine neoplasms are the most common. Often the diagnosis occurs randomly on endoscopic examination. Circulating markers, functional combined with conventional imaging contributes to the diagnosis and management. Treatment depends on type, grade and stage of the tumor.
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Affiliation(s)
- Elisa Giannetta
- Dept. of Experimental Medicine, "Sapienza" University of Rome, Italy.
| | - Valentina Guarnotta
- Biomedical Department of Internal and Specialist Medicine (DIBIMIS), Section of Endocrine-Metabolic Diseases, University of Palermo, Italy
| | - Francesca Rota
- Unit of Endocrinology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Federica de Cicco
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Federica Grillo
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova and Ospedale Policlinico San Martino, Genova, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Antongiulio Faggiano
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G. Pascale", IRCCS, Naples, Italy
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Yamamoto M, Ozawa S, Koyanagi K, Oguma J, Kazuno A, Ninomiya Y, Yatabe K, Kajiwara H. Effectiveness of neoadjuvant chemotherapy with etoposide and cisplatin followed by surgery for esophageal neuroendocrine carcinoma: a case report. J Thorac Dis 2018; 10:E450-E455. [PMID: 30069403 DOI: 10.21037/jtd.2018.05.170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Miho Yamamoto
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Soji Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Junya Oguma
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Akihito Kazuno
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Yamato Ninomiya
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Kentaro Yatabe
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroshi Kajiwara
- Department of Pathology, Tokai University School of Medicine, Kanagawa, Japan
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Tustumi F, Takeda FR, Uema RH, Pereira GLS, Sallum RAA, Cecconello I. Primary neuroendocrine neoplasm of the esophagus - Report of 14 cases from a single institute and review of the literature. ARQUIVOS DE GASTROENTEROLOGIA 2017; 54:4-10. [PMID: 28079231 DOI: 10.1590/s0004-2803.2017v54n1-01] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 08/22/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND: Most prevalent esophageal neoplasm is squamous cell carcinoma and adenocarcinoma. Other tumors are uncommon and poorly studied. Primary neuroendocrine esophageal neoplasm is a rare carcinoma and most of its therapy management is based on lung neuroendocrine studies. Neuroendocrine tumors can be clustered in the following subtypes: high grade (small cell carcinoma or large cell carcinoma) and low grade (carcinoids). OBJECTIVE: The present study aims to assess clinical and pathological neuroendocrine esophageal tumors in a single oncologic center. METHODS: A retrospective analysis of patients and review of the literatures was performed. RESULTS: Fourteen patients were identified as neuroendocrine tumors, 11 male and 3 female patients. Mean age was 67.3 years old. Ten patients were classified as small cell, 3 as large cell and 1 as carcinoid. Four patients presented squamous cell carcinoma simultaneously and 1 also presented adenocarcinoma. Main sites of metastasis were liver, peritoneum, lung and bones. Most patients died before 2 years of follow-up. Patient with longer survival died at 35 months after diagnosis. CONCLUSION: Neuroendocrine esophageal tumors are rare; affect mainly men in their sixties or seventies. High grade tumors can be mixed to other subtypes neoplasms, such as adenocarcinoma and squamous cell carcinoma. Most of these patients have poor overall survival rates.
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Affiliation(s)
- Francisco Tustumi
- Cirurgia do Aparelho Digestivo, Faculdade de Medicina, Hospital das Clínicas, USP, SP, Brasil
| | | | - Rodrigo Hideki Uema
- Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, SP, Brasil
| | | | | | - Ivan Cecconello
- Cirurgia do Aparelho Digestivo, Faculdade de Medicina, Hospital das Clínicas, USP, SP, Brasil
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Wang HH, Zaorsky NG, Meng MB, Wu ZQ, Zeng XL, Jiang B, Jiang C, Zhao LJ, Yuan ZY, Wang P. Multimodality therapy is recommended for limited-stage combined small cell esophageal carcinoma. Onco Targets Ther 2015; 8:437-44. [PMID: 25709477 PMCID: PMC4335610 DOI: 10.2147/ott.s76048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and aim Limited-stage combined small cell esophageal carcinoma (LS-C-SCEC) is a rare, poorly understood, underdiagnosed disease, with components of both small cell esophageal cancer and non–small cell esophageal cancer. We investigated the optimal treatment strategy and prognostic factors in patients with LS-C-SCEC. Patients and methods LS-C-SCEC patients included in the analysis (from our hospital and the literature) were treated between January 1966 and December 2013. Patient treatment strategies included surgery (S), chemotherapy (CT), and radiation therapy (RT). The primary end point was overall survival (OS); the secondary end points included tumor complete response rates, patterns of failure, and toxicity. Kaplan–Meier curves were compared with the log-rank test. Univariate and multivariate analyses were used to determine prognosticators for OS. Results A total of 72 patients were included in the analysis: 24 (33%) from our hospital and 48 (67%) from the literature. The median OS of all patients was 15.0 months. Patients who received CT had a significantly longer median OS than did those who did not (OS 22.8 months vs 10.0 months) (P=0.03). Patients treated with multimodality therapy (including RT+CT [18%], S+CT [40%], or S+RT+CT [17%]) vs monotherapy (typically, S [18%]) had significantly improved OS (15.5 months vs 9.3 months) (P=0.02) and complete response rates. On multivariate analysis, tumor location (upper third of the esophagus) and type of treatment (monotherapy) were the only factors predictive of poor OS. Conclusion Multimodality therapy (including RT+CT, S+CT, or S+RT+CT) improves OS for patients with LS-C-SCEC compared with monotherapy (typically, S). Additional studies are necessary to personalize multimodal treatment approaches to individual patients.
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Affiliation(s)
- Huan-Huan Wang
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mao-Bin Meng
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Zhi-Qiang Wu
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Xian-Liang Zeng
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Bo Jiang
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Chao Jiang
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Lu-Jun Zhao
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Zhi-Yong Yuan
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Ping Wang
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
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Li J, Chen X, Shen Y, Hou Y, Zhang S, Wang H, Feng M, Tan L, Wang Q, Zeng Z. A rare collision tumor of squamous carcinoma and small cell carcinoma in esophagus involved with separate lymph nodes: a case report. J Thorac Dis 2013; 5:E203-6. [PMID: 24255793 DOI: 10.3978/j.issn.2072-1439.2013.09.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 09/18/2013] [Indexed: 01/26/2023]
Abstract
We report a case of an esophageal collision tumor composed of squamous cell carcinoma and small cell carcinoma (SmCC). A 66-year-old man complained of chest pain after oral intake for nearly one month. The patient received two cycles of neoadjuvant platinum-based combination chemotherapy and enhanced computed tomography showed a partial response of the tumor. He then underwent a thoracolaparoscopic esophagectomy with extensive mediastinal lymphadenectomy. Two cycles of chemotherapy and prophylactic irradiation of the lymphatic drainage region were sequentially achieved after surgery. The patient has survived for more than 18 months with no evidence of recurrent disease since surgical resection.
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Affiliation(s)
- Jingpei Li
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
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Schuerle T, Aoun E, Farah K. Small cell carcinoma of the oesophagus: a rare cause of dysphagia. BMJ Case Rep 2013; 2013:bcr-2013-200468. [PMID: 24001733 DOI: 10.1136/bcr-2013-200468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Primary small cell carcinoma of the oesophagus is a rare, highly aggressive malignancy with diagnosis usually occurring at the most advanced stages. We report a case of small cell carcinoma of the oesophagus presenting with dysphagia and melena. A 79-year-old Caucasian man presented to an outside hospital with dizziness, light-headedness, chest pain and melena for 3 days. He had a history of intermittent dysphagia for solids and a 25-pound weight loss in the past 2 months. He underwent an esophagogastroduodenoscopy that revealed a large polypoid, well-circumscribed friable oesophageal mass causing near complete obstruction of the lumen. This mass extended into the gastric cardia. Oesophageal biopsies were consistent with small cell neuroendocrine carcinoma. He underwent chemotherapy with subsequent remission and developed recurrence of disease in the oesophagus 2 years later. Overall, the patient has had two recurrences of his disease but has survived for more than 2 years with chemotherapy alone.
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Affiliation(s)
- Theresa Schuerle
- West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA
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A rare cause of the cough: primary small cell carcinoma of esophagus-case report. Case Rep Med 2012; 2012:870783. [PMID: 22461794 PMCID: PMC3296277 DOI: 10.1155/2012/870783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 12/06/2011] [Accepted: 12/11/2011] [Indexed: 11/17/2022] Open
Abstract
Primary small cell carcinoma of the esophagus is a relatively rare malignancy. It is highly progressive and poorly prognostic in untreated conditions. In the western populations, the rate of primary small cell carcinoma in all esophageal cancer types is between 0.05% and 2.4%, while it is endemically increasing up to 7.6% in the eastern populations. Most of the cases are in extensive stage at the time of diagnosis. Surgery is the treatment of choice in limited stages, but treatment must be multimodal in primary small cell carcinoma of the esophagus. A 47-year-old woman was referred to our clinic with gradually increasing severe dry cough and slight difficulty in swallowing for 20 days. Chest X-ray graphy was normal, and computed tomography of the chest showed multiple mediastinal lymph nodes and hepatic metastases. Her endoscopic examination revealed an endoluminal vegetative mass between 20 cm and 23 cm of her esophagus. The case was reported as small cell carcinoma of the esophagus on histopathological examination. The case was assumed inoperable, and chemotherapy and radiotherapy were planned. We presented a rare cause of the cough and primary esophageal small cell carcinoma in this paper.
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Lu J, Xue LY, Lu N, Zou SM, Liu XY, Wen P. Superficial primary small cell carcinoma of the esophagus: clinicopathological and immunohistochemical analysis of 15 cases. Dis Esophagus 2010; 23:153-9. [PMID: 19515193 DOI: 10.1111/j.1442-2050.2009.00981.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary esophageal small cell carcinoma (PESCC) is a relatively rare and aggressive tumor with poor prognosis. Systemic spreading and metastasis often occur at diagnosis. Although 5-year survival rate of superficial squamous cell carcinoma of the esophagus can be 86.1%, 5-year survival rate of superficial PESCC is still relatively low. This study mainly retrospectively analyzed clinicopathological and immunohistochemical features of 15 cases of superficial PESCC in our hospital from 1990 to 2004, in order to find suitable diagnostic markers and applicable therapies for this disease. The records mainly included presenting symptoms, demographics, diagnostic method, histopathology, follow-up, and therapy. Immunohistochemical staining of chromogranin A (CgA), neuron-specific enolase (NSE), synaptophysin (Syn), neuronal cell adhesion molecules (CD56), thyroid transcription factor-1 (TTF-1), cytokeration 34betaE12 (CK34betaE12), cytokeratin (AE1/AE3), and cytokeratin 10/13 was performed. Incidence of superficial PESCC accounted for 4.8% of that of superficial carcinoma of the esophagus during the same period. Initial symptoms of all patients were dysphagia or accompanied with retrosternal pain and upper abdominal pain, and duration of these symptoms was 75 days averagely. Mean age of patients was 58.8 years old, and the male-to-female ratio was 2.75 : 1. Lesions were mainly located at middle thoracic esophagus. One, 2, and 5-year survival rates were 66.7, 33.3, and 6.7%, respectively. The median survival time was 19 months and mean survival time was 23.7 months after diagnosis. The percentages of PESCC samples with positive immunoreactivity were NSE 100%, Syn 100%, AE1/AE3 100%, CD56 93.3%, TTF-1 60%, CgA 53.3%, CK34betaE12 6.7%, and cytokeratin 10/13 0%, respectively. Our study suggested that PESCC was a rare and aggressive tumor with high malignancy. Superficial PESCC had rapid progression and poor prognosis compared with superficial squamous cell carcinoma of the esophagus at the same stage. The systemic therapy based on combination of postoperative chemotherapy and radiotherapy might be an effective approach for the treatment of superficial PESCC as a systemic disease. Higher proportion of positive labeling of NSE, Syn, AE1/AE3, CD56, TTF-1, and CgA in PESCC was valuably applied in diagnosis and differential diagnosis.
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Affiliation(s)
- J Lu
- Department of Pathology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
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Wu Z, Ma JY, Yang JJ, Zhao YF, Zhang SF. Primary small cell carcinoma of esophagus: Report of 9 cases and review of literature. World J Gastroenterol 2004; 10:3680-2. [PMID: 15534932 PMCID: PMC4612018 DOI: 10.3748/wjg.v10.i24.3680] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To analyze the clinical manifestations, pathological features and treatment of primary small cell carcinoma (SCC) of the esophagus and to review the literature on this entity.
METHODS: The records of 9 patients with primary esophageal small cell carcinoma were examined and the demographic data, presenting symptoms, methods of tumor diagnosis, and types of treatment given, response to treatment, pathologic findings, and clinical outcome were reviewed. Features of mixed patterns of histological differentiation and lymph node metastases were specifically sought.
RESULTS: All the patients reported dysphagia, weight loss and chest pain as the initial symptoms. In 5 cases the tumors were located in the mid-esophagus, 3 cases in the lower third of the esophagus and 1 case in the upper third. The average length of esophageal involvement was 5 cm. They underwent radical resection, regional lymph node clearance and esophageal-stomach anastomosis in thorax or at neck. Two patients had a stage IIa disease, five had a stage IIb disease, and the other two had a stage III disease of International Union Contrele Cancer (UICC). All of them were histologically and immunohistochemically confirmed SCC of esophagus. Immunohistochemical staining for neuron-specific enolase (NSE), synaptophsin (Syn) and chromogranin A exhibited strong immunoreactivity in all specimens. Three of the nine resected specimens showed foci of squamous cell carcinoma in situ. Metastasis was present in 7 of 9 adjacent lymph nodes. All the patients survived the operations and made an uneventful postoperative recovery. They received adjuvant systemic chemotherapy and local radiation therapy after discharge. During follow-up, three patients developed multiple liver, brain, lung and bone metastases and died between 5 and 18 mo after the diagnosis. Three patients developed widespread metastasis disease and died between 18 and 37 mo after the diagnosis. There was no local tumor recurrence in these 6 patients. The other three patients were lost during follow-up.
CONCLUSION: Primary small cell carcinoma of the esophagus is a rare but very malignant tumor. Radical resection combined with chemotherapy and radiotherapy is helpful in limited stage cases.
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Affiliation(s)
- Zhu Wu
- Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
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Brenner B, Tang LH, Klimstra DS, Kelsen DP. Small-Cell Carcinomas of the Gastrointestinal Tract: A Review. J Clin Oncol 2004; 22:2730-9. [PMID: 15226341 DOI: 10.1200/jco.2004.09.075] [Citation(s) in RCA: 200] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PurposeTo improve our understanding of the entity of small-cell carcinoma (SmCC) of the gastrointestinal (GI) tract.MethodsA MEDLINE search was done, using the terms “small cell carcinoma” or “oat cell carcinoma” combined with “gastrointestinal” or with any of the GI sites, for the period 1970 to 2003. The 138 eligible reports identified in this way were reviewed for clinical data.ResultsTo date, approximately 544 cases of GI SmCC have been reported. The disease represents 0.1% to 1% of all GI malignancies, with the esophagus being the most common primary site. A majority of patients present with overt distant metastases. Systemic symptoms are common; ectopic hormonal secretion may occur. By light microscopy, GI SmCCs are essentially indistinguishable from primary pulmonary SmCC. The presence of non-SmCC components is common. Data from molecular analysis of the disease has identified some similarities to pulmonary SmCC. Chemotherapy represents the main treatment option, with modest impact on survival. In locoregional disease, the literature suggests that treatment be initiated using chemoradiotherapy and then, if metastatic disease is still excluded, surgical resection be considered. The disease is highly aggressive, and survival is in the range of several weeks for untreated patients and of 6 to 12 months for those receiving therapy.ConclusionSmCC of the GI tract is a rare and lethal disease. Although there are many similarities to pulmonary SmCC, some differences between the two entities are suggested. While chemotherapy can achieve significant palliation, surgery may have a potential impact on long-term survival of patients with locoregional disease.
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Affiliation(s)
- Baruch Brenner
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill School of Medicine, Cornell University, New York, NY 10021, USA
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