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Yokota Y, Anzai H, Nagai Y, Sonoda H, Shinagawa T, Yoshioka Y, Abe S, Yokoyama Y, Matsuzaki H, Emoto S, Murono K, Sasaki K, Nozawa H, Ushiku T, Ishihara S. Neuroendocrine carcinoma associated with chronic ulcerative colitis: a case report and review of the literature. Ann Coloproctol 2024; 40:S32-S37. [PMID: 37073552 PMCID: PMC11162842 DOI: 10.3393/ac.2022.00801.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 04/20/2023] Open
Abstract
Adenocarcinoma is a common histological type of ulcerative colitis-associated cancer (UCAC), whereas neuroendocrine carcinoma (NEC) is extremely rare. UCAC is generally diagnosed at an advanced stage, even with regular surveillance colonoscopy. A 41-year-old man with a 17-year history of UC began receiving surveillance colonoscopy at the age of 37 years; 2 years later, dysplasia was detected in the sigmoid colon, and he underwent colonoscopy every 3 to 6 months. Approximately 1.5 years thereafter, a flat adenocarcinoma lesion occurred in the rectum. Flat lesions with high-grade dysplasia were found in the sigmoid colon and surrounding area. The patient underwent laparoscopic total proctocolectomy and ileal pouch-anal anastomosis with ileostomy. Adenocarcinoma was diagnosed in the sigmoid colon and NEC in the rectum. One year postoperation, recurrence or metastasis was not evident. Regular surveillance colonoscopy is important in patients with long-term UC. A histological examination of UCAC might demonstrate NEC.
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Affiliation(s)
- Yumi Yokota
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Anzai
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuzo Nagai
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Sonoda
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahide Shinagawa
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yoshioka
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinya Abe
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Matsuzaki
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Division of Pathology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Alía Navarro V, Martínez Delfrade Í, De Frutos González B, Morón García B, Barrill Corpa AM, Sotoca Rubio P, Peñas García B, Ferrer Gómez A, Perna Monroy C, Ferreiro Monteagudo R. Localized Colonic Small-Cell Carcinoma with Pathological Complete Response after Neoadjuvant Cisplatin and Etoposide: A Case Report. Curr Oncol 2023; 30:8426-8433. [PMID: 37754528 PMCID: PMC10528221 DOI: 10.3390/curroncol30090613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Extrapulmonary small-cell carcinoma (SCC) is a rare neoplasm that shares certain features with its pulmonary counterpart and occurs predominantly in the gastrointestinal tract (GIT). It is a high-grade and poorly differentiated neuroendocrine tumor, usually diagnosed in advanced stages, with a poor prognosis and few therapeutic options in that setting. This is a case report of a 77-year-old Spanish male patient with localized SCC of the colon, who presented a pathological complete response in the surgical specimen after neoadjuvant chemotherapy with cisplatin and etoposide. To date, 5 years after surgery, the patient remains without evidence of tumor recurrence. As clinical guidelines for the management of this entity are lacking, and therefore its management has not been standardized, an attempt to summarize the current evidence in the literature was made.
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Affiliation(s)
- Víctor Alía Navarro
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
| | - Íñigo Martínez Delfrade
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Belén De Frutos González
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Blanca Morón García
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Ana María Barrill Corpa
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
| | - Pilar Sotoca Rubio
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
| | - Beatriz Peñas García
- Gastroenterology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | - Ana Ferrer Gómez
- Pathology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | | | - Reyes Ferreiro Monteagudo
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Biomedical Research Network in Cancer (CIBERONC), 28029 Madrid, Spain
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Li K, Liu Y, Han J, Gui J, Zhang X. The genetic alterations of rectal neuroendocrine tumor and indications for therapy and prognosis: a systematic review. Endocr J 2023; 70:197-205. [PMID: 36403965 DOI: 10.1507/endocrj.ej22-0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Neuroendocrine tumors (NETs) are a type of rare tumor that can occur at multiple organs. Rectal NETs are the most common NETs in gastrointestinal tract. Due to the rarity of rectal NETs in rectal cancer, the molecular features and the correlation with patient therapeutic response and prognosis have not been investigated in detail. In this review, we focused on the molecular features, potential therapeutic targets and prognosis of rectal NETs. By summarizing the relevant studies, we established the mutational landscape of rectal NETs and identified a series of large fragment variations. Driver genes including TP53, APC, KRAS, BRAF, RB1, CDKN2A and PTEN were found as the top mutated genes. Large fragment alterations mainly involved known driver genes, including APC, TP53, CCNE1, MYC, TERT, RB1 and ATM. Germline mutations of APC, MUTYH, MSH6, MLH1 and MSH2 associated with Lynch syndrome or FAP were also found in rectal NETs. The BRAF-V600E mutation was reported as an actionable target in rectal NETs, and the combined BRAF/MEK inhibitors were found to be effective targeting BRAF-V600E in advanced or metastatic NETs. The known prognostic risk factors of rectal adenocarcinoma, including a series of demographic and clinicopathological factors were also prognostic factors for rectal NETs. Furthermore, three types of markers, including genetic alterations, protein expression levels and methylation, were also suggested as prognostic factors for rectal NETs. In summary, we established the landscape of mutations and large-fragment alterations of rectal NETs, and identified potential therapeutic targets and a series of prognostic factors. Future studies may focus on the optimization of therapeutic strategies based on potential actionable biomarkers.
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Affiliation(s)
- Ke Li
- Department of Endocrinology, Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing 101300, China
| | - Ying Liu
- Department of Endocrinology, Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing 101300, China
| | - Junge Han
- Department of Endocrinology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing 102400, China
| | - Jianhua Gui
- Department of Endocrinology, Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing 101300, China
| | - Xiuyuan Zhang
- Department of Endocrinology, Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing 101300, China
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Bolzacchini E, Chini C, Cortelezzi CC, Vallini I, Pinotti G, La Rosa S, Uccella S. Poorly Differentiated Neuroendocrine Carcinoma of the Sigmoid Tract in Long-Standing Ulcerative Colitis: Report of a Case and Review of the Literature. Int J Surg Pathol 2018; 26:479-483. [DOI: 10.1177/1066896917752443] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 37-year-old male with long-standing and extensive ulcerative pancolitis developed a rapidly lethal poorly differentiated neuroendocrine carcinoma (NEC) in the sigmoid colon. Prior biopsies obtained from multiple sites of the colon during endoscopic surveillance showed minimal inflammatory changes and no sign of dysplasia. Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal malignancies, and adenocarcinoma is the most common type of colorectal neoplasm associated with ulcerative colitis and Crohn’s disease, but other types of epithelial and nonepithelial tumors have also been described in IBD. NECs arising in the setting of ulcerative colitis are very rare and are reported as anecdotic findings. We describe the clinicopathological features of an IBD-related NEC and review the previously reported cases.
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Hayashi H, Miyagi Y, Sekiyama A, Yoshida S, Nakao S, Okamoto N, Koganei K, Sugita A. Colorectal small cell carcinoma in ulcerative colitis with identical rare p53 gene mutation to associated adenocarcinoma and dysplasia. J Crohns Colitis 2012; 6:112-5. [PMID: 22261536 DOI: 10.1016/j.crohns.2011.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/09/2011] [Accepted: 08/11/2011] [Indexed: 02/07/2023]
Abstract
Colorectal small cell carcinomas (SCCs) are rare tumors and are infrequently associated with ulcerative colitis (UC). We report a case of primary rectal SCC combined with adenocarcinoma arising in left-sided UC. Immunohistochemically, tumor cells were positive for chromogranin A, synaptophysin, and CD56 in the SCC but not in the adenocarcinoma. The patient simultaneously developed multiple lesions of adenocarcinoma and high-grade dysplasia in the sigmoid colon and rectum. To elucidate whether SCC might evolve from multipotential cells in dysplasia and/or adenocarcinoma, we examined the mutational status of TP53 and KRAS. The same clonality of these lesions including SCC was confirmed by the presence of an identical single nucleotide point mutation in TP53. KRAS mutation was not observed in these lesions. Thus, these lesions seem to have developed from the same origin. Long-standing inflammation leading to dysplasia might be responsible for the development of some SCCs in UC particularly when they are combined with dysplasia and/or adenocarcinoma.
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Affiliation(s)
- Hiroyuki Hayashi
- Department of Pathology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama 240-8555, Japan.
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Kosmidis C, Efthimiadis C, Anthimidis G, Vasiliadou K, Tzeveleki I, Fotiadis P, Basdanis G. Small cell carcinoma in ulcerative colitis--new treatment option: a case report. World J Surg Oncol 2010; 8:100. [PMID: 21087512 PMCID: PMC2999595 DOI: 10.1186/1477-7819-8-100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 11/18/2010] [Indexed: 11/24/2022] Open
Abstract
Background The most common type of carcinoma associated with ulcerative colitis (UC) is adenocarcinoma. We present a case of primary rectal small cell carcinoma in a patient with a history of UC. Methods A 34-year-old male diagnosed with UC for 10 years was not consistent with the usual annual follow-up and presented with mucoid-bloody diarrhea. Colonoscopy revealed a rectal mass 2 cm distant from the anal verge. The patient underwent a total proctocolectomy with preservation of the anal sphincters, construction of an ileal reservoir, anastomosis of the reservoir to the anus (J configuration) and protective loop ileostomy. Results Histological examination showed undifferentiated small cell carcinoma. Conclusions This is the first case of small cell carcinoma in a background of UC reported to be treated surgically and the patient and has no reccurence 18 months postoperatively.
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Abstract
Colorectal neuroendocrine tumors (NETs) originate from neuroendocrine cells in the intestinal tract, and represent a small area within oncology, but one which has provided increasing new data during the past years. Although the World Health Organization has determined clinical and histological features to predict prognosis for such tumors, they may not be valid on an individual basis. We aim to give an overview of the recent findings with regard to pathology, molecular genetics and diagnosis of NETs.
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Abstract
A 48-year old male with longstanding and extensive pancolitis developed a high grade and rapidly lethal malignant lesion in the ascending colon characterized by a neuroendocrine carcinoma. Prior biopsies obtained from multiple sites in the colon during endoscopic surveillance were reported to show only inflammatory changes without dysplasia. Although operator-dependent, repeated endoscopic studies may have limitations during surveillance programs because the biological behavior of some colonic neoplastic lesions may have a rapid and very aggressive clinical course.
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Grassia R, Bodini P, Dizioli P, Staiano T, Iiritano E, Bianchi G, Buffoli F. Neuroendocrine carcinomas arising in ulcerative colitis: Coincidences or possible correlations? World J Gastroenterol 2009; 15:4193-5. [PMID: 19725156 PMCID: PMC2738818 DOI: 10.3748/wjg.15.4193] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal malignancies. Adenocarcinoma is the commonest type of colorectal neoplasm associated with ulcerative colitis (UC) and Crohn’s disease, but other types of epithelial and non-epithelial tumors have also been described in inflamed bowel. With regards to non-epithelial malignancies, lymphomas and sarcomas represent the largest group of tumors reported in association with IBD, especially in immunosuppressed patients. Carcinoids and in particular neuroendocrine neoplasms other than carcinoids (NENs) are rare tumors and are infrequently described in the setting of IBD. Thus, this association requires further investigation. We report two cases of neoplasms arising in mild left-sided UC with immunohistochemical staining for neuroendocrine markers: a large cell and a small cell neuroendocrine carcinoma of the rectum. The two patients were different in age (35 years vs 77 years) and disease duration (11 years vs 27 years), and both had never received immunosuppressant drugs. Although the patients underwent regular endoscopic and histological follow-up, the two neoplasms were locally advanced at diagnosis. One of the two patients developed multiple liver metastases and died 15 mo after diagnosis. These findings confirm the aggressiveness and the poor prognosis of NENs compared to colorectal adenocarcinoma. While carcinoids seem to be coincidentally associated with IBD, NENs may also arise in this setting. In fact, long-standing inflammation could be directly responsible for the development of pancellular dysplasia involving epithelial, goblet, Paneth and neuroendocrine cells. It has yet to be established which IBD patients have a higher risk of developing NENs.
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Kanat O, Qzet A, Ataergin S, Komurcu S, Onguru O. Small cell carcinoma of the large bowel: a rare, but very aggressive malignancy. Am J Gastroenterol 2006; 101:2440-1. [PMID: 17032213 DOI: 10.1111/j.1572-0241.2006.00742_8.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Chapet O, Corcelle-Requin A, Padovani L, Bizollon MH, Mérieux C, Trillet-Lenoir V, Gérard JP. [Anorectal neuroendocrine carcinoma and small cell carcinoma. Report of two cases]. Rev Med Interne 2001; 22:1109-15. [PMID: 11817122 DOI: 10.1016/s0248-8663(01)00475-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Anorectal neuroendocrine small cell carcinomas are rare and frequently difficult to treat. EXEGESIS Two women presented with a fungating tumor located on the upper part of the anal canal. Histology displayed neuron-specific enolase and chromogranin A immunoreactive small cell tumors. A plasmatic neuron-specific enolase secretion was noticed in one case. Tumors were poorly reactive to chemotherapy and irradiation, less than in usual epidermoid anal canal cancer. Evolution was quickly leading to hepatic and pulmonary metastases in both cases. CONCLUSION Anorectal neuroendocrine small cell carcinomas are rare but need to be individualized from epidermoid anal canal tumors owing to their poor prognosis with a frequent occurrence of hepatic and pulmonary metastasis.
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Affiliation(s)
- O Chapet
- Service de radiothérapie-oncologie, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite, France
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 28-2000. A 34-year-old man with ulcerative colitis and a large perirectal mass. N Engl J Med 2000; 343:794-800. [PMID: 10984569 DOI: 10.1056/nejm200009143431108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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