Ultrastructural and immunocytochemical definition of component neoplasms in an unusual gastro-oesophageal collision tumour

A rare rarity: Neuroendocrine tumor of the esophagus

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.

A unique tripartite collision tumor of the esophagus: A case report

RATIONALE

We report a unique case of a tripartite esophageal collision tumor consisting of three separate histologic types.

PATIENTS CONCERNS

Therapeutic dilemmas on the proper treatment of those rare neoplasms remain unanswered considering both proper surgical therapy and adjuvant therapy.

DIAGNOSE

In this paper, we report a unique case of a patient with a tripartite esophageal collision tumor consisting of a small cell carcinoma, an adenocarcinoma of medium differentiation and a signet ring cell carcinoma. Diagnosis is difficult as clinical presentation of the patient was undistinguishable from other, commoner tumor types.

INTERVENTIONS

The patient's diagnostic and therapeutic course along with available data on the collisions tumor's biological behavior and treatment are briefly discussed.

OUTCOMES

Esophagectomy is the best treatment options for these patients. Unique nature of this tumor demands aggresive oncologic treatment.

LESSONS

Collision tumors are rare neoplasms consisting of distinct cell populations developing in juxtaposition to one another without any areas of intermingling. Various cell types can be found. However, collision neoplasms of the esophagus combining adenomatous and neuroendocrine components are exceedingly rare, with only 5 cases described to date in the literature. Given their rarity, limited information is available on their tumorigenesis, biological behavior and clinical course. In general, these tumors are aggressive neoplasms and significantly affect patient treatment and prognosis.

Primary neuroendocrine neoplasm of the esophagus - Report of 14 cases from a single institute and review of the literature

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.

Gastric small-cell carcinoma in Japan: a case report and review of the literature

The authors encountered a patient with primary gastric small-cell carcinoma (primary gastric SCC). Histologic examination revealed combined carcinoma containing non-small-cell elements such as adenocarcinoma and squamous cell differentiation. On preoperative biopsy, only well-differentiated adenocarcinoma was collected. Since gastric SCC was first reported in 1976, this type of carcinoma has been detected in 54 patients in Japan. Concerning these cases, the authors reviewed the light and/or electron microscopic findings of neuroendocrine granules, positive reaction for neuron-specific enolase staining, and the histologic type of resected specimens. There were only three patients positive for neuron-specific enolase in which light and electron microscopy demonstrated neuroendocrine granules. However, 50 patients (approximately 93%) overall satisfied at least one of these findings. Concerning the histologic characteristics of the resected specimens, multidirectional differentiation was more markedly observed compared with that in SCC of the lung. Adenocarcinomatous and/or squamous differentiation was observed in more than half the cases, and preoperative biopsy suggested carcinoma other than SCC or undifferentiated carcinoma in several cases.