Esophageal carcinoid tumor treated by endoscopic resection

Abstract

The present report describes a rare case of esophageal carcinoid tumor that was treated by endoscopic resection. A 43-year-old woman underwent esophagogastroduodenoscopy at her family clinic for screening of the upper digestive tract and a small lesion resembling a submucosal tumor was detected in the lower esophagus. A biopsy sample from the lesion was diagnosed as esophageal carcinoid tumor and the patient visited our hospital for detailed examination. The tumor was approximately 3 mm in diameter and its surface appeared to be covered with normal squamous epithelium. The tumor had a shiny reddish surface without ulceration or erosion. Magnifying endoscopy with narrow-band imaging showed structures resembling reticular vessels under the epithelium. Endoscopic ultrasonography depicted the tumor as a low-echoic mass within the lamina propria. Computed tomography did not detect the tumor and no metastatic lesions were evident in other organs. With the patient's informed consent, the tumor was resected using endoscopic submucosal dissection, with a sufficient free margin in both the vertical and horizontal directions. Magnifying endoscopic examination showed the resected tumor to have abundant reticular vessels. Finally, the tumor was diagnosed immunopathologically as an esophageal carcinoid tumor (neuroendocrine cell tumor, grade 1), without lymphatic or vascular invasion.

Progress in the treatment of esophageal neuroendocrine carcinoma

“…32 Yagi et al 33 reported a rare case of esophageal carcinoid tumor with endoscopic esophageal submucosal tumors of ~3 mm in diameter, a rosy glossy surface, and no ulceration or erosion on magnifying endoscopy with narrow-band imaging. Magnifying endoscopy with narrow-band imaging showed a submucosal microvascular network structure.…”

Difficult Preoperative Diagnosis of Lymphoepithelioma-Like Carcinoma of the Esophagus

“…6 Those of esophageal carcinoid tumor were reported to resemble subepithelial reticular vessels on a shiny reddish surface. 10 Obviously, further studies are required to establish the utility of NBI-ME for preoperative diagnosis of esophageal LELC, and further accumulation of the cases might unmask its unique clinical features, such as prognosis.…”

Evolving role of the endoscopist in management of gastrointestinal neuroendocrine tumors

“…A 2009 review identified only 25 reported cases in the previous 4 decades[9]. There are no established guidelines for treatment, which is thus dictated by provider experience and patient preference.…”

“…Esophageal NETs limited to the submucosal layer (without involvement of the muscularis propria) can be removed easily and safely[16]. In fact, endoscopic removal has been utilized frequently for esophageal NETs localized to submucosal layer and ≤ 10 mm in diameter without ulceration or erosion as these lesions had low probability for lymph node metastasis[9]. The threshold of 10 mm as the maximum size recommended for endoscopic resection of esophageal NET is based not on a large body of evidence for this location, but rather on extrapolation of data from gastric and rectal NETs, which have shown higher rates of lymph node metastases when lesions exceed 10 mm in size.…”

“…EMR can allow an en bloc resection of a small lesion, though some authors have posited that ESD is preferable as EMR can lead to mechanical damage and limited pathological evaluation of the resected specimen[9]. ESD can enable complete removal of the tumor while maintaining an adequate horizontal margin for histologic review to ensure complete removal.…”