885
SCIENTIFIC LETTERS
An esophageal neuroendocrine
tumor in a Barrett’s esophagus
successfully treated with endoscopic
resection
Keywords: Esophageal neuroendocrine tumor. Barrett’s
esophagus.
Dear Editor,
Neuroendocrine tumors (NET) rarely occur in the esopha-
gus as the neuroendocrine system is not well developed
in this area (1). The incidence varies depending upon the
country studied (2).
Case report
A 77-year-old male presented to our Endoscopy Unit for
radiofrequency ablation of Barrett’s esophagus (BE) with
high-grade dysplasia (HGD). At the time of the endosco-
py, a flat elevated lesion of 16-18 mm in diameter with a
central depression was identified over a BE (C2M3 Prague
classification). Endoscopic ultrasound was performed at
the same time and the lesion was limited to the mucosa;
no lymphadenopathy was observed. A mucosectomy tech-
nique was performed with bands. The histological analysis
showed a 5 mm focus in the mucosa of a poorly differen-
tiated NET with a positive immunohistochemical study for
synaptophysin and Pan CK. The proliferation index was
greater than 50 % (Fig. 1). Eight weeks later, BE remained
in the follow-up gastroscopy with no other lesion. The new
biopsy showed only HGD. The PET/CT scan was negative
during follow-up.
Discussion
NETs are epithelial neoplasms composed of cells with either
a well-developed neuroendocrine phenotype or with poorly
developed but still recognizable and prominent neuroendo-
crine features (2), in which each component (exocrine and
neuroendocrine differentiation) represents at least 30 % of
the lesion (3).
REV ESP ENFERM DIG 2020:112(11):885-886
DOI: 10.17235/reed.2020.6907/2020
A B
C D
Fig. 1. NET. A. Tumor population arranged in irregular
nests of intensely basophilic infiltration with wide free
margins. B. Tumor population under higher magnification
(HE, 40x). C. Ki67 expression (proliferation index) in
more than 50 % of the cells (Ki67, 20x). D. Positive
immunoreaction for synaptophysin.
The esophageal NET (E-NET) can be associated as an inci-
dental finding in BE in some cases, as it is believed that they
have a common origin of stem cells (4). There is currently no
standard TNM staging system proposed for E-NET and there
is no data on the prognosis, treatment or follow-up of these
lesions, although several authors suggest that the main strat-
egy is a combination of surgery, chemotherapy and radio-
therapy. Endoscopy resection is acceptable in lesions smaller
than 1 cm with good results, due to a low frequency of lymph
node involvement or distant metastasis (4,5). Despite the size
of the NET and the wide free margins, we suggest long-term
follow up due to the lack of knowledge of this tumor in BE.
María Belvis Jiménez, María Fernanda Guerra Veloz
and Manuel Rodríguez-Téllez
Gastroenterology Department. Endoscopy Unit. Hospital Universitario Virgen
Macarena. Sevilla, Spain
DOI: 10.17235/reed.2020.6907/2020
1130-0108/2020/112/11/885-886  •  REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
© Copyright 2020. SEPD y © ARÁN EDICIONES, S.L.
886 M. Belvis Jiménez et al.
References
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REV ESP ENFERM DIG 2020:112(11):885-886
DOI: 10.17235/reed.2020.6907/2020