Colorectal neuroendocrine carcinoma: A case report and review of the literature

Abstract

BACKGROUND Colorectal neuroendocrine carcinoma (NEC) is a rare tumor that demonstrates aggressive growth pattern with ingrowth into the tract, metastasis to the other organs, and invasion to the surrounding organs; these clinical characteristics result in poor prognosis. Surgical resection appears as an effective approach; however, because it is difficult to accurately diagnose NEC during the early stage and owing to its aggressive growth pattern, development of a reliable standard chemotherapy regimen and management strategies are essential. CASE SUMMARY Here, we report the case of patient with NEC showing an aggressive growth pattern that resulted in the rupture of the tumor to the outside the colon after stenting of the internal colonic stenosis. In addition, the tumor invaded into the duodenum, thereby causing duodenal stenosis that required an additional stent in the duodenum. This aggressive growth pattern is one of the main features of the NEC that is different from adenocarcinoma. To clarify the clinical characteristics, we reviewed 60 recently reported cases, including data on tumor location, size, treatment, and prognosis. CONCLUSION We consider that the information presented here is of great significance for the diagnosis, treatment, and management of symptoms of the patients with NEC.

Incarcerated sigmoid large-cell neuroendocrine carcinoma in an inguinal hernia

“…To date, the treatment of colorectal NECs is not well-defined. Surgery plus chemotherapy are reported to improve overall survival compared with chemotherapy alone [ 6 ].…”

Mixed epithelial endocrine neoplasms of the colon and rectum – An evolution over time: A systematic review

“…Benign and malignant epithelial neoplasms of the colon and rectum are common with colorectal cancer being the second commonest cancer in Canada[ 1 ]. Gastroenteropancreatic neuroendocrine neoplasms have been studied in detail[ 68 , 69 ] with few dedicated reports of endocrine/ neuroendocrine cell carcinomas of the colon and rectum[ 70 , 71 ]. Reviews on mixed neuroendocrine and non-neuroendocrine neoplasms of the digestive system that include colon and rectum are limited[ 15 , 18 , 72 - 75 ].…”

“…Distinguishing between MANEC and adenocarcinoma using endoscopic imaging is difficult[ 79 ]. Although CT may be normal in some patients, positron emission tomography-computer tomography (PET-CT) usually will show 18F-fludeoxyglucose-avid lesion as it associates with high sensitivity and proliferation of the tumor (NEC component) and is therefore recommended when mixed epithelial/endocrine tumors are suspected or to detect metastatic disease[ 30 , 38 , 71 ]. However as its sensitivity in colorectal adenocarcinoma and neuroendocrine tumors is low (42.0% and 33%, respectively), it is therefore deemed as inapplicable in routine clinical practice: Thus evaluating the stage of MANEC using CT images, lacks efficacy[ 79 ].…”

“…The most important factor for improving outcome of MANEC remains early and accurate diagnosis with adequate histopathological examination to establish the presence of two components within the same neoplasm[ 39 , 71 ]. This often requires a diligent search for morphologically different areas on the haematoxylin and eosin stained sections and liberal use of immunohistochemical markers[ 20 ].…”

“…There is however, continued controversy whether MiNENs/MEENs have a better or worse prognosis than pure NEC[ 18 ]. The biological behavior of MiNENs/MEENs is predominantly driven by the endocrine component, which in more than 90% of cases is poorly differentiated and once metastasized, high grade neuroendocrine carcinoma carries a very poor prognosis with no definitive curative treatment options[ 18 , 43 , 71 , 73 ]. Compared to survival rate of patients with adenocarcinoma, survival rate of MANEC patients is substantially worse[ 14 ].…”