Cases Of Esophageal Carcinoma Research Articles

Three resected cases of esophageal carcinoma considered as being secondary solid tumors after bone marrow transplantation

BackgroundBone marrow transplantation is now an established treatment for some hematopoietic disorders and hematopoietic malignancies, and secondary solid tumors that develop after bone marrow transplantation have begun to attract attention.Case presentationHerein, we report 3 cases of esophageal carcinoma that developed after bone marrow transplantation. Case 1: 40-year-old female received cyclophosphamide and total body irradiation at 12 Gy for acute myeloid leukemia, followed by related bone marrow transplantation. She developed chronic graft-versus-host disease manifesting as pulmonary complications and was administered cyclosporine. Nine years after the transplantation, she was diagnosed as having esophageal carcinoma Stage II and underwent radical surgery. She died of the primary disease 17 months after the surgery. Case 2: A 45-year-old male patient received cyclophosphamide, VP-16 and total body irradiation at 13.2 Gy for acute lymphocytic leukemia, followed by related bone marrow transplantation. He developed chronic graft-versus-host disease manifesting as liver dysfunction. Fifteen years after the transplantation, he was diagnosed as having esophageal carcinoma Stage II and underwent radical surgery. Seven months after the surgery, he died of the primary disease. Case 3: A 30-year-old female patient received cyclophosphamide and total body irradiation at 3 Gy for Fanconi anemia, followed by unrelated bone marrow transplantation. She developed chronic graft-versus-host disease manifesting as a rash and was administered tacrolimus and methotrexate. Fifteen years after the transplantation, she was diagnosed as having esophageal carcinoma Stage III and underwent radical surgery. She died of sepsis 7 months after the surgery.ConclusionThe esophageal carcinomas developing after bone marrow transplantation had the characteristics of secondary solid tumors in all 3 patients, such as early onset, after total body irradiation, association with chronic graft-versus-host disease, and history of use of immunosuppressive drugs. Patients undergoing bone marrow transplantation require long-term follow-up after the transplantation, considering the possible development of secondary solid tumors, and in regard to secondary solid tumors developing in the gastrointestinal tract, it must be borne in mind that the risk of esophageal carcinoma is particularly high.

Nomogram for predicting the overall survival of the patients with oesophageal signet ring cell carcinoma.

BackgroundThe purpose of this study was to explore the prognostic factors of oesophageal signet ring cell (SRC) carcinoma and to construct a nomogram for predicting the outcome of SRC carcinoma of oesophagus.MethodsA total of 968 cases of oesophageal SRC carcinoma were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2016. Cases were divided into training cohort and validation cohort. Univariate and multivariable Cox analyses was performed to select the predictors of overall survival (OS for the nomogram. The performance of nomogram was validated with Harrell’s concordance index (C-index), calibration curves and decision curve analysis (DCA).ResultsThe 1- and 5-year OS in the training cohort were 0.446 and 0.146, respectively, and the 1- and 5-year OS in the validation cohort were 0.459 and 0.138. The independent prognostic factors for establishing the nomogram were marital status, invasion of the surrounding tissue, lymph node metastasis, distant metastasis, surgery and chemotherapy. The Harrell’s c-index value of the training cohort and validation cohort were 0.723 and 0.708. In the calibration curves, the predicted survival probability and the actual survival probability have a considerable consistency. DCA indicated the favourable potential clinical utility of the nomogram.ConclusionsA nomogram to predict the OS of patients with oesophageal SRC carcinoma was established. The validation of the nomogram fully demonstrates its great performance.

Secondary esophageal squamous cell carcinoma after hematopoietic stem cell transplantation.

We evaluated cases of esophageal squamous cell carcinoma (ESCC) that developed after allogeneic hematopoietic stem cell transplantation (allo-HSCT) at our institution. Allo-HSCT was performed in 1534 patients (1776 cases) at our institution from 2001 to 2016. Overall, 602 patients were confirmed to have survived for 2 or more years and 154 underwent upper gastrointestinal endoscopy at least 1-year post-transplantation. ESCC was discovered in 17 patients (1.1%), 15 of whom had 31 lesions discovered at our institution (ESCC group). A retrospective comparative study was conducted with the remaining 137 patients for whom no ESCC was noted (non-ESCC group), and we also evaluated the clinicopathological characteristics of the ESCC group. History of TBI (total body irradiation) and bone marrow transplant was significantly higher in the ESCC group. The mean time from transplantation to detection of ESCC was 82.3months. Localization was upper thoracic in 12 cases, middle thoracic in 10, cervical in 4, lower thoracic in 3, and upper to lower thoracic in 2. Treatment comprised endoscopic submucosal dissection in 23 cases, surgery in 4, untreated due to worsening primary disease in 3, and chemoradiotherapy in 1. In this study, lesions were located in the cervical to upper thoracic esophagus in approximately 60% of all secondary ESCC cases after allo-HSCT. History of TBI and bone marrow transplantation are high risk of ESCC, and proactive screening endoscopy is desirable.

Expression of CD44 and CD133 stem cell markers in squamous cell carcinoma of esophagus.

Role of cancer stem cells in the esophageal carcinogenesis is not clear. To assess the expression of CD44 and CD133 cancer stem cell markers in esophageal squamous cell carcinoma (ESCC) and its predisposing lesions by immunohistochemistry. Prospective study as a part of an intramural research project. Tissues samples were obtained with endoscopic biopsy and from surgically resected esophageal specimens. Fifty cases each of histopathologically diagnosed cases of esophageal squamous cell carcinoma and its predisposing lesions (mild, moderate, and severe dysplasia and esophagitis) were evaluated for stem cell marker CD44 and C133 by immunohistochemistry using a scoring system. Chi-square test, analysis of variance (ANOVA), post-hoc tests (Tukey-HSD) were used as appropriate for data analysis. Two sided P < 0.05 was considered as significant. CD44 expression was significantly higher in ESCC as compared to dysplasia and esophagitis (mean IS 7.92 ± 1.45 vs. 6.34 ± 0.80 vs 5.15 ± 0.86 respectively, P < 0.001). CD133 expression was also significantly higher in ESCC as compared to dysplasia (mean IS 6.82 ± 1.57 vs. 1.00 ± 0.00 respectively, P < 0.001) while esophagitis showed no expression. CD44 and CD133 expressions were significantly higher in poorly differentiated ESCC than moderately differentiated and well differentiated lesions (CD44 mean IS 6.94 ± 1.44 vs 8.17 ± 1.38 vs. 8.63 ± 1.02 respectively, P < 0.001 and CD 133 mean IRS 5.63 ± 0.81 vs 6.00 ± 00 vs. 9.0 ± 00 respectively, P < 0.001). Significantly higher expression of CD44 and CD133 cancer stem cell markers in ESCC as compared to its predisposing lesions (esophagitis and dysplasia) suggests its role in esophageal carcinogenesis.

Adenocarcinoma of the Gastroesophageal Junction with Synchronous Renal Cell Carcinoma: A Case Report and Literature Review

Abstract Gastroesophageal junction adenocarcinoma is a rare type of cancer of the esophagus. It is usually diagnosed in advanced stages and much less frequently in the earlier stage, where surgical treatment is essential. Surgical treatment is also essential in kidney cancer. The occurrence of synchronous malignancies with an esophageal malignancy is a well-described phenomenon with an incidence ranging from 3.6 to 27.1%. To the best of our knowledge, only 11 cases of synchronous esophageal and renal cell carcinoma (RCC) have been previously described. We present a patient operated simultaneously for cancer of the gastroesophageal junction with synchronous renal cell carcinoma. The finding in the kidney was accidentally discovered by the routine CT scan on the occasion of the relatively early carcinoma of the gastroesophageal junction detected by upper endoscopy. The patient was admitted to the Thoracic Surgery Department, where Ivor-Lewis gastroesophagoplasty and right nephrectomy simultaneously were performed. The patient was followed for 5 years without evidence of disease progression.

Successful reconstruction of an intrathoracic tracheal defect using a muscle flap and conchal cartilage graft

Malignant invasion of the respiratory tract is a common complication in advanced cases of esophageal carcinoma. Resection and reconstruction can be extremely challenging, particularly when the invasion is intrathoracic. A circumferential tracheal resection with direct tracheal closure or mediastinal tracheostomy is often performed, but the outcome is not always favorable, with high morbidity rates, loss of vocal function, and reduced quality of life. We present our experience in performing an intrathoracic tracheal reconstruction in which a conchal cartilage graft was used in combination witha pectoralis major muscle transposition. This was successfully done following the noncircumferential resection of the intrathoracic trachea due to mural invasion by a metastatic lymph node of esophageal carcinoma. We believe this report will contribute to the growing body of clinical expertise on procedures for intrathoracic tracheal reconstruction.

The expression of p53 protein and its clinicopathological features and prognosis of esophageal spindle cell carcinoma

Objective: To evaluate the association of p53 protein expression with clinicopathological features and prognosis in esophageal spindle cell carcinoma. Methods: A total of 4 439 esophageal squamous cell carcinoma (ESCC) patients who underwent radical esophagectomy without neoadjuvant therapy between May 2010 and May 2019 were included. The HE slides and clinicopathological parameters were reviewed. Among these, there were 63 cases of esophageal spindle cell carcinoma; p53 protein expression was evaluated by immunohistochemistry (IHC) and its correlation with clinicopathological parameters and patients' outcome was analyzed. Results: The 63 esophageal spindle cell carcinoma accounted for 1.4% (63/4 439) of all ESCC. Of the 63 patients there were 55 males and 8 females, male to female ratio was 7∶1. The p53 protein mutation expression rate was 77.8% (49/63), including 14 cases with wild-type expression, 22 with nonsense mutation expression, and 27 with missense mutation expression. The concordance rate of p53 protein expression between carcinoma components and spindle cell components was 100%. Survival analysis showed that p53 protein mutation expression was significantly correlated with overall survival (OS, P=0.044), patients with p53 protein mutation expression had poorer OS. Conclusion: p53 protein expression is highly concordant in the squamous cell carcinoma components and spindle cell components of esophageal spindle cell carcinoma; its mutation expression is associated with poor outcome of the patients.

Is the Histopathological Subtype Important for Tumor Response to Irradiation in non-metastatic Esophageal Cancers

Esophageal cancer is still a health problem in middle income countries. The up-front treatment in localized disease is crucial for a better survival. Data from literature are in favor of a better response to radiotherapy of squamous histology. We have run a retrospective study to compare the response of histological subtypes of esophageal cancer to radiotherapy according to irradiation. Of 44 cases (53.7%) of squamous cell localized esophageal carcinoma and 38 (46.3%) of adenocarcinoma, the response after radiotherapy containing multimodal neoadjuvant treatment was 29.5% (13pts) versus 39.5% (15pts) (p=0.475). No correlation was found between histology and tumor shrinkage. Survival was found similar between the two subgroups. Indeed, median relapse free survival was 11 months for both groups with 95% CI [8.86-13.13] or 95% CI [4.526-17.47], log rank 0.394 and median overall survival was 12 months, 95% CI [9.44-14.55] in squamous versus 15 months, 95% [8.30-21.69] in adenocarcinoma cases, log rank 0.195. In univariate regression, the median relapse free survival was significantly associated with irradiation dose and the concomitance of chemotherapy to radiotherapy, while in multivariate analysis only the last variable remained significant: HR 0.425, 95% CI [0.225-0.806], p=0.009. Our analysis showed a tendency to a better response in adenocarcinoma esophageal cancer after multimodal radiotherapy containing treatment.

KRT 15 as a prognostic biomarker is highly expressed in esophageal carcinoma.

Aim: To investigate the expression and prognostic value of KRT 15 in esophageal carcinoma. Materials & methods: The expression levels of KRT 15 were measured in 128 cases of esophageal carcinoma and matched adjacent normal tissues by immunohistochemistry and Western blot assays. Results & conclusion: Western blot analysis shown the expression levels of KRT 15 in esophageal carcinoma were significantly higher compared with those in matched adjacent normal tissues (p < 0.001). immunohistochemistry result shown the high-expression rate of KRT 15 in esophageal carcinoma were 56.3%, which was significantly higher than those in normal tissues (35.9%; p = 0.002). KRT 15 high-expression correlated with T stage, lymph node metastasis, tumor node metastasis stage and prognosis (p < 0.05). These data indicate KRT 15 as a prognostic biomarker is highly expressed in esophageal carcinoma.

Removal of tumor thrombus from the azygos vein in an esophageal squamous cell carcinoma patient

BackgroundEsophageal squamous cell carcinoma with tumor thrombus in the arch of the azygos vein has not been reported to date. Neoadjuvant chemotherapy can decrease the stage in patients with advanced preoperative tumor staging, regaining surgical opportunities and significantly prolonging progression-free survival and overall survival. Herein, we present a case of esophageal squamous cell carcinoma accompanied by tumor thrombus in the arch of the azygos vein, and the patient underwent radical surgery after neoadjuvant chemotherapy.Case presentationA 63-year-old male with esophageal squamous cell carcinoma was found to have tumor thrombus formation in the arch of the azygos vein. Four courses of neoadjuvant chemotherapy with the TP regimen (paclitaxel plus nedaplatin) were given. Reexamination revealed a significant reduction in tumor and tumor thrombus volume. Therefore, McKeown radical resection for esophageal cancer and removal of the tumor thrombus in the arch of the azygos vein were performed. Postoperative pathology suggested complete remission of the esophageal tumor and the presence of small focal cancer tissues in the arch of the azygos vein.ConclusionWe report a case of esophageal squamous cell carcinoma with tumor thrombus formation in the azygos vein. We conducted radical resection after 4 rounds of neoadjuvant chemotherapy, and the pathological results revealed complete remission of the tumor. We report our experience addressing this rare case, and we hope to find the underlying mechanism of tumor thrombus formation and whether it has any effects on prognosis in our future study.

Tumoral Expression of CD166 in Human Esophageal Squamous Cell Carcinoma: Implications for Cancer Progression and Prognosis.

Accumulating data showed that cancer stem cells (CSCs) identified by cell surface markers contribute to the initiation, progression, and prognosis of human cancers. In this study, the expression of CSC candidates CD166, CD44, and Lgr5 in 65 cases of esophageal squamous cell carcinoma (ESCC) and 16 cases of control esophageal tissues were examined with immunohistochemistry (IHC). The correlation between tumoral expression levels of these CSC candidates and clinicopathological variables was analyzed. IHC results showed that the expression of CD166 in esophageal control tissues was completely negative, but it was in 87.69% (57/65) ESCC tissues. The expression of CD44 and Lgr5 did not differ between esophageal control tissues and ESCC tissues (p > 0.05). In addition, there were not correlations found among the expression levels of CD166, CD44, and Lgr5 in ESCC tissues. Clinicopathological analysis revealed that the tumoral expression level of CD166 correlated with lymph node involvement and TNM staging in patients with ESCC, and lower tumoral expression of CD44 was found in patients with advanced TNM staging. Kaplan-Meier survival curves suggested that expression level of CD166 appeared to have a negative impact on overall survival rate after surgery in patients with ESCC. Such impact was not found in other two CSC candidates. The authors therefore conclude that CD166 is a potential prognostic biomarker and correlates with advanced progression features in patients with ESCC.

Body mass index and risk of upper gastrointestinal cancer: A 30-year follow-up of the Linxian dysplasia nutrition intervention trial cohort

BackgroundAlthough a number of previous studies have noted the association between body mass index (BMI) and upper gastrointestinal (UGI) cancer risk, little evidence exists in the Chinese esophageal squamous dysplasia population. This prospective study investigated the association between BMI and UGI cancer risk in the Linxian Dysplasia Nutrition Intervention Trial (NIT) cohort. MethodsA total of 3298 participants were included in the final analysis. Asian-specific BMI cut-offs were used to define BMI subgroups: underweight <18.5 kg/m2, normal ≥18.5 to <24 kg/m2 and overweight or obese ≥24 kg/m2. Hazard ratios (HRs) and 95 % confidence intervals (95 %CIs) were estimated using the Cox proportional hazard model. ResultsDuring over 30 years of follow-up we identified 654 incident esophageal squamous-cell carcinoma (ESCC) cases and 434 gastric cancer cases which included 88 gastric non-cardia carcinoma (GNCC) and 346 gastric cardia carcinoma (GCC) cases. Relative to normal weight, overweight or obesity were associated with a significantly reduced risk of ESCC (HR 0.69, 95 %CI 0.48–0.98) after multivariate adjustment, including age at baseline, gender, smoking, drinking, family history of cancer, education and consumption of fresh fruit. Subgroup analyses found that clear effects were evident in women and subjects with a family history of cancer. No association with gastric cancer was observed in any subjects or subgroups. ConclusionOverweight/obesity was associated with decreased risk of ESCC in this dysplasia population, particularly in women and persons who had a family history of cancer. Future studies are needed to confirm these findings.

A Case of Esophageal Carcinoma who Developed Disturbance of Consciousness due to Hyperammonemia during Neoadjuvant Chemotherapy

A Case of Esophageal Carcinoma who Developed Disturbance of Consciousness due to Hyperammonemia during Neoadjuvant Chemotherapy

Case of Concurrent Esophageal Neuroendocrine Carcinoma and Squamous Cell Carcinoma

Case of Concurrent Esophageal Neuroendocrine Carcinoma and Squamous Cell Carcinoma

A Resected Case of Esophageal Basaloid Squamous Cell Carcinoma Demonstrating a Complete Response to Neoadjuvant Chemotherapy of 5-FU and Nedaplatin

A Resected Case of Esophageal Basaloid Squamous Cell Carcinoma Demonstrating a Complete Response to Neoadjuvant Chemotherapy of 5-FU and Nedaplatin

Clinical Features and Advantages of a Novel Percutaneous Endoscopic Gastrostomy Method.

BackgroundTo study the clinical characteristics of novel percutaneous endoscopic gastrostomy.Material/MethodsWe retrospectively analyzed the hospital records of 173 patients undergoing various methods of gastrostomy (a novel PEG, traditional PEG, and surgical gastrostomy). Clinical characteristics were analyzed. For the novel PEG, the operation was as same as the traditional method for initial steps until the annular guide wire was inserted. The following steps were different: water was injected through an injection port to expand the capsule, then the water sac was confirmed to be close to the gastric wall under endoscope, and, finally, the incision was sutured and covered.ResultsPatient ages ranged from 42 to 93 years (60.8±9.2 years, 91 males and 82 females). Among all patients, there were 27 cases of brain trauma, 42 cases of cerebral infarction, 74 cases of esophageal or cardiac carcinoma, 21 cases of laryngocarcinoma, and 9 cases of Alzheimer disease. Clinical features were significantly better for novel PEG compared to traditional PEG: duration of operation (19.75±3.14 min vs. 37.86±5.33 min and 54.12±9.48 min, P<0.001), intraoperative blood loss (27.14±3.63 ml vs. 43.53±6.24 ml and 75.78±12.41 ml, P<0.001), postoperative pain score (1.12±0.19 pts vs. 3.85±0.44 pts and 6.22±1.06 pts; P<0.001), infection rate (1.35% vs. 3.77% and 2.17%, P<0.001), length of hospital stay (3.16±0.42 d vs. 5.68±0.78 d and 8.29±1.31 d, P<0.001), and time to free activity (2.24±0.26h vs. 3.74±0.48 h and 14.85±2.38 d, P<0.001). The incidence of complications such as wound infection (1.35% vs. 3.77% and 4.76%), vomiting (1.35% vs. 5.66% and 6.52%), and nausea (2.70% vs. 1.88% and 6.52%) in the novel PEG group was lower than in the other groups (P<0.0001). Improved outcomes were obtained without increased medical costs in the novel PEG group.ConclusionsFor patients with difficult postoperative oral nutrition, the novel PEG treatment resulted in overall better clinical outcomes than traditional PEG.

Comparison of survival between neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy followed by surgery for esophageal squamous cell carcinoma

Objective To compare the effect of neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT) on the survival of patients with esophageal cancer. Methods Clinical data of 275 cases of thoracic esophageal squamous cell carcinoma treated with neoadjuvant therapy combined with surgery from December 2011 to December 2015 were analyzed retrospectively. The data of treatment and follow-up were complete and analyzable. There were 70 cases in the NCRT group and 205 cases in the NCT group. The survival rate was calculated by Kaplan-Meier method and statistically compared by log-rank test, and multivariate analysis was performed by Cox regression model. Results The median follow-up time was 32(3-84) months. The median survival time and recurrence-free survival time was 42(3-84) months and 30(3-84) months, respectively. The overall 3-and 5-year survival rates were 56.8% and 45.9%, respectively, and the 3-and 5-year recurrence-free survival rates were 45.1% and 38.9%, respectively. The median survival time in the NCRT and NCT groups was 46(7-84) and 40(4-74) months, and the median recurrence-free survival time was 31(3-84) and 28(3-69) months, respectively. The 3-and 5-year overall survival of the two groups were 59.1%, 47.1% and 56.3%, 47.5%(P=0.515), and the 3-and 5-year recurrence-free survival were 44.5%, 40.1% and 47%, 39%, respectively. There was no significant difference in the survival between two neoadjuvant therapy modes (P=0.554). Multivariate analysis showed that postoperative pathological TNM staging was an independent factor affecting the prognosis of patients with esophageal cancer (P=0.001). Conclusions The survival results of NCRT are similar to those of NCT. Postoperative pathological staging is an independent survival factor. Key words: Esophageal neoplasm/neoadjuvant radiotherapy; Esophageal neoplasm/neoadjuvant chemotherapy; Prognosis

138P - Incidence of supracarinal lymph node positivity in operated cases of total esophagectomy: Short term results from a tertiary cancer centre

BackgroundThe extent of lymphadenectomy in esophageal carcinoma (EC) has been subject of debate since several decades. Published literature is lacking in concrete evidence of supracarinal pathological lymph node (LN) involvement in middle and lower third EC, and its impact on oncologic outcomes. We present short-term institutional data for the rate of pathological supracarinal LN positivity in operated cases of EC. MethodsA prospective study was conducted with ethics approval from April 2017 to August 2018. Patients of mid or lower third EC who were candidates for surgery were included. A supracarinal dissection was carried out separately in all the patients in addition to the standard two-field lymphadanectomy. Harvested nodal stations were labeled individually according to the Japanese Esophageal Classification and sent for histopathological examination. Outcomes were recorded in the postoperative period as well as during follow-up. ResultsOf the 76 patients that underwent an esophagectomy, 73 were squamous cell carcinomas whereas only 3 were adenocarcinomas. 44 (57.9%) of patients were stage II, 22 (28.9%) were stage III, and 7 (9.2%) were stage IB. 44 (57.9%) patients had prior chemoradiation, 9 (11.8%) had neoadjuvant chemotherapy whereas 18 (23.6%) did not receive any therapy prior to surgery. 26 (34.2%) cases were found to have pathological mediastinal nodes, of which supracarinal pathological nodes were found in 20 (26.3%) patients. Pathological supracarinal nodes were found in 16/51 (31.37%) patients with tumors of the middle one-third, and in 4/25 (16%) patients with lower one-third tumors. Average supracarinal LN yield was 10.33 (range- 2-32) nodes. 5 (6.5%) patients had only supracarinal LN positive for malignancy. 5 (6.57%) patients had pulmonary complications, 4 (4.52%) had RLN injury/ permanent hoarseness, and 6 (7.8%) had an anastomotic leak. In-hospital mortality was 4(5.2%). ConclusionsExtended two field with supracarinal lymphadenectomy is strongly recommended in cases of middle third EC, who have received neoadjuvant treatment, although it should be considered even for lower third or gastroesophageal junction tumors. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Immunohistochemical analysis of tumor budding as predictor of lymph node metastasis from superficial esophageal squamous cell carcinoma.

Tumor budding is known predictors of lymph node metastasis from esophageal squamous cell carcinoma. However, it is not easy to detect such small cell clusters on hematoxylin-eosin (HE) staining. Therefore, we evaluated tumor budding using immunohistochemistry (IHC) for epithelial cell markers. We analyzed tumor budding in 50 cases of superficial esophageal squamous cell carcinoma. We evaluated the impact of clinicopathological factors and tumor budding to predict lymph node metastasis. A total of 565 tumor sections were assessed using HE staining and IHC for cytokeratin 5/6. Based on receiver operating characteristic curves, the cut-off values for high-grade tumor budding evaluated using HE staining or IHC were 2 and 11, respectively. High-grade tumor budding evaluated using HE staining (P = 0.007) and IHC (P ≤ 0.001) were significantly correlated with lymph node metastasis. For tumors with pT1a-MM to pT1b-SM1, high-grade tumor budding evaluated using IHC was correlated with lymph node metastasis (P = 0.050). Tumor budding was significantly associated with lymph node metastasis. The optimal cut-off values of tumor budding on HE staining and tumor budding on IHC were 2 and 11, respectively. Even though both tumor budding on HE staining and tumor budding on IHC were significantly associated with lymph node metastasis, tumor budding on IHC tend to be more associated with lymph node metastasis.

1843 A Rare Case of Large Cell Neuroendocrine Carcinoma of the Esophagus

INTRODUCTION: Neuroendocrine Tumors (NETs) are a rare form of esophageal malignancy with an incidence ranging from 0.4 and 2% of all malignant esophageal tumors (1). Among esophageal NETs, the vast majority are small cell esophageal carcinomas. A recent literature review found only 35 cases of large cell esophageal carcinoma have been reported since 1952 (2). CASE DESCRIPTION/METHODS: Patient is a 48-year-old male with past medical history of HTN, diabetes, and HLD who presented with 6 weeks of progressive dysphagia predominantly to solids. The dysphagia was initially infrequent, but eventually occurred every time he ate. ROS was pertinent for a 20 lb weight loss. Social history was pertinent for 1-2 drinks of alcohol per month and daily use of chewing tobacco. Family history revealed a mother with a brain mass and a grandmother with pancreatic CA. PE was normal. He underwent an EGD which showed a large, ulcerative distal esophageal mass extending into gastric cardia. Biopsies revealed a poorly differentiated carcinoma most compatible with large cell neuroendocrine carcinoma. CT imaging of chest, abdomen, and pelvis showed nonspecific lower esophageal mural thickening with no evidence of esophageal mass. PET scan showed hypermetabolic distal esophageal mass measuring 6 x 5 x 3 cm with peri gastric lymph node involvement. The patient underwent neoadjuvant treatment with radiation, cisplatin and etoposide followed by a distal esophagectomy with gastric pull-through. Surgical path revealed Stage III large cell neuroendocrine carcinoma involving the distal esophagus, proximal stomach, and peri gastric lymph nodes. Patient is currently recovering from the surgery with plans for postoperative chemotherapy. DISCUSSION: This case illustrates an rare form of a malignant esophageal neuroendocrine tumor. Esophageal NETs tend to be more aggressive than NETs found in other parts of the GI tract, so early diagnosis and treatment is critical in order to prolong survival. Due to a paucity of cases in the literature, there is a need for more cases to be presented in order to better understand the course of the disease and determine the best modalities for treatment.