Small cell carcinoma of the oesophagus: a rare cause of dysphagia

Epigastric Pain and Dysphagia in a 36-Year-Old Man Due to Primary Esophageal Small Cell Carcinoma

BACKGROUND Small cell carcinoma is an aggressive malignant neuroendocrine tumor that most commonly occurs in the lung. Primary small cell carcinoma of the esophagus (PSCCE) is rare and is an aggressive malignancy with poor prognosis and no clear management guidelines. This report describes the case of a 36-year-old man presenting with epigastric pain, dysphagia, and melena due to a primary esophageal small cell carcinoma. CASE REPORT A 36-year-old presented to the Emergency Department (ED) with epigastric pain associated with food intake. Initial workup was unremarkable, and a presumed clinical diagnosis of reflux esophagitis and peptic strictures was made, prompting empiric treatment with anti-secretory therapies. Despite these therapies, he presented to the emergency room with progressively worsening dysphagia. Endoscopic examination (EGD) revealed a large necrotic mass, and computed tomography (CT) imaging revealed liver metastasis. Biopsies from both the liver and esophageal masses confirmed small cell carcinoma. His clinical course was complicated by a broncho-esophageal fistula, leading to massive hemoptysis, necessitating intubation. Unfortunately, his condition deteriorated rapidly, and he chose to pursue hospice care. He died 3 months after his initial presentation. CONCLUSIONS This report has presented a rare case of primary esophageal small cell carcinoma and our approach to management. We highlight the importance of early diagnosis, supported by histopathology, and the need for management guidelines.

Primary small cell esophageal carcinoma, chemotherapy sequential immunotherapy: A case report

BACKGROUND

Primary small cell esophageal carcinoma (PSCEC) is aggressive and rare, with a worse prognosis than other subtypes esophageal carcinoma. No definitive and optimum standard guidelines are established for treating it. Herein, we report a case of PSCEC, including a current literature review of PSCEC.

CASE SUMMARY

A 79-year-old male was diagnosed PSCEC with multiple lymph node metastasis thorough computed tomography, positron emission tomography-computed tomography, endoscopy and pathology. Surgery was not suitable for this patient. He was treated with etoposide 100 mg/m² and cisplatin 25 mg/m² on days 1-3, every 3 wk for 4 cycles. The tumor and lymph nodes became smaller and dysphagia and vomiting symptoms improved. The patient could not tolerate subsequent chemotherapy (CT) because of hematological toxicity; therefore, we performed immunotherapy (durvalumab, 1500 mg) every 4 wk. At present the patient has received 12 cycles immunotherapy over about 1 year. He is still receiving treatment and follow-up.

CONCLUSION

PSCEC with multiple lymph nodes metastasis does not always indicate surgery. CT may extend survival time and improve the quality of life in the absence of surgery. Immunotherapy or immunotherapy plus CT may also work as a treatment for PSCEC.

Primary small cell carcinoma of the esophagus: progression in the last decade

Primary small cell carcinoma of the esophagus (PSCCE) is a highly malignant tumor that is diagnosed by endoscopic biopsy and immunohistochemistry. Because of its low incidence, a high degree of malignancy, and rapid progress, it is difficult to conduct large, randomized controlled trials and to establish a standard treatment plan for this disease. In recent years, several retrospective studies have been reported, and with the rise of emerging therapies, PSCCE has gradually become a focus of thoracic surgery. This paper reviews progress in the diagnosis and treatment of PSCCE in recent years.

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.

Significance of expression of p53, nm23 and Ki-67 in esophageal neuroendocrine carcinoma

AIM: To investigate the significance of expression of p53, nm23 and Ki-67 in esophageal neuroendocrine carcinoma.

METHODS: The expression of p53, nm23 and Ki-67 in 42 esophageal neuroendocrine carcinoma specimens was assessed by immunohistochemistry.

RESULTS: The positive expression rate of p53 in esophageal neuroendocrine carcinoma was 97.62%, and the high expression rate was 90.48%; the positive expression rate of nm23 was 57.14%, and the high expression rate was 33.33%; the positive expression rate of Ki-67 was 97.62%, and the high expression rate was 61.90%. p53 and Ki-67 were highly expressed in esophageal neuroendocrine carcinoma. The expression of p53 and Ki-67 in esophageal neuroendocrine carcinoma had no significant association with age, sex, tumor site, pathological classification, depth of invasion or lymphatic metastasis (P > 0.05). The expression of nm23 had no significant association with age, sex, tumor site, or pathological classification (P > 0.05), but was significantly associated with depth of invasion and lymphatic metastasis (P < 0.05).

CONCLUSION: The biological behavior and immunophenotype of esophageal neuroendocrine carcinoma are different from those of other malignant tumors. High expression of p53 and Ki-67 has a close relationship with poor prognosis. The examination of p53, Ki-67 and nm23 expression may be helpful to judge prognosis of esophageal neuroendocrine carcinoma.