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It is only for medical professionals' reference.
Clinically, most of the patients with huge abdominal masses we see are often caused by delays in treatment, and today I want to share with you a case.
It took only two weeks for the mass to appear to fill the liver.
…What kind of disease is it, and it progresses so fast? A middle-aged man came to the Gastroenterology Department with a huge mass in his abdomen.
.
.
the man had a pale yellow face and was weak all over.
On physical examination, he found that there was a huge mass on his abdomen, the texture was hard, like an iron pan buckled in his abdominal cavity.
Such a hard mass is almost always caused by malignant tumors.
We asked the patient, “How long has this mass appeared, why not come to the hospital earlier?” The patient said, “The appearance of this mass is only two weeks, the mass grows very fast, and the belly is difficult to distend.
Eat, so come and see the doctor as soon as possible.
"Such a big lump has grown in two weeks? Did the patient make a mistake? Asking the patient and family members carefully, they all indicated that the mass did indeed grow out within two weeks.
A CT scan of the abdomen in the outer hospital indicated that the mass was actually an enlarged liver, which was suspected to be liver metastatic cancer.
We first did a contrast-enhanced ultrasound and found that it was indeed liver metastatic cancer.
Since the patient did not provide other uncomfortable symptoms, we performed a liver biopsy while making an appointment with enhanced CT to look for the primary tumor.
AB Figure 1: Chest enhanced CT image; A.
Venous phase; B.
Arterial phase AB Figure 2: Abdominal enhanced CT image; A.
Arterial phase; B.
The results of enhanced CT in the portal phase found that the esophagus occupied space and multiple liver metastases . The pathological results of the liver biopsy suggest that it is a malignant tumor, which looks like a small cell carcinoma, and needs to be further confirmed by immunohistochemistry.
Combined with the results of multiple examinations, the maze finally revealed that the results of immunohistochemistry were consistent with the characteristics of small cell carcinoma.
The result of gastroscopy revealed that there was indeed a malignant tumor in the middle part of the esophagus, and the result of pathological examination of the esophagus was also small cell carcinoma.
So far, the mystery is completely solved.
The patient is suffering from a rare esophageal malignant tumor with a high degree of malignancy, primary esophageal small cell carcinoma (PESC).
Small cell carcinoma is a highly malignant tumor that usually occurs in the lung.
Small cell carcinoma outside the lung is relatively rare, accounting for only 2.
5% to 4.
1% of small cell carcinoma.
The esophagus is a common occurrence of small cell carcinoma outside the lung.
Location.
PESC is a poorly differentiated esophageal neuroendocrine tumor, a rare tumor of the esophagus, accounting for only 0.
4% to 2.
8% of esophageal cancer, its malignant degree is high, and the 5-year survival rate is extremely low.
Figure 3: NSE results of patients.
PESC patients are mostly middle-aged and elderly people between 50 and 70 years old, and there are more men than women.
Its clinical manifestations are similar to other types of esophageal cancer, and carcinoid syndromes may occur, such as flushing, edema, diarrhea, cramping abdominal pain, etc.
, and blood test NSE is elevated.
Our patient is a 57-year-old middle-aged male with no symptoms of carcinoid syndrome.
The tumor series showed a significant increase in NSE.
Figure 4: Results of other tumor series of patients.
There are two methods for PESC staging.
One is the TNM clinical staging of esophageal cancer, and the other is based on the standard staging method of the American Veterans Hospital and the International Association for Lung Cancer Research, which is divided into limited stages.
(Limited disease, LD) and extensive disease (ED), LD refers to no lymph node metastasis or only regional lymph node metastasis, the disease is limited to the esophagus and surrounding tissues; ED refers to the disease with distant lymph nodes or distant organs Transfer.
The most common metastatic site of PESC is the liver, followed by lung metastasis and bone metastasis.
Our patient came to see a doctor with symptoms caused by compression of abdominal organs caused by rapid liver metastasis.
PESC is very similar to lung small cell carcinoma under a light microscope.
The tumor is composed of small anaplastic cells, the size is similar to small lymphocytes, the division image is easy to see, and the cytoplasm is very small.
The immunophenotype of PESC presents dual features of epithelial and neuroendocrine.
According to the 2010 World Health Organization (WHO) diagnostic criteria for gastrointestinal neuroendocrine tumors, the diagnosis of PESC must meet the following four points: ①The morphology and structure of tumor cells under HE staining conform to the characteristics of small cell carcinoma; ②The Ki67 positive index is greater than 20% Or mitotic images greater than 20/high power field; ③Immunohistochemical detection of neuroendocrine markers, such as Syn, CgA, CD56, NSE, etc.
, at least one must be positive; ④Exclude neuroendocrine cancer in other parts.
Our patients all meet these four diagnostic criteria.
Currently, surgery is the first choice for limited-stage PESC, and the principles of surgery are the same as other esophageal tumors.
For patients with extensive stages of distant metastasis, the combined treatment effect of chemotherapy and radiotherapy is significantly better than simple treatment.
The combined use of endocrine therapy and targeted therapy can significantly prolong the survival time of limited-stage patients.
AB Figure 5: The pathological results of the patient’s liver biopsy with HE staining A.
x20 times B.
x40 times AB Figure 6: The patient’s esophageal tumor Syn immunohistochemistry report; A.
x20 times; B.
x40 times It is a pity, our patient It is a patient with extensive liver metastasis, and the liver is full of metastatic cancers.
The liver function is extremely poor.
It is unable to perform surgery, and cannot tolerate such active treatment methods as chemotherapy, radiotherapy and targeted therapy.
It can only be used Some drugs are used to relieve the suffering of patients.
Faced with such patients, our doctor is both distressed and helpless.
Reference materials: [1]Zhu Y,Qiu B,Liu H,et al.
Primary small cell carcinoma of the esophagus:review of 64 cases from a single institution.
Dis Esophagus.
2014;27(2):152-158.
[ 2] Wu Xiao, Yang Haijun, Gao Sheqian, Zhou Fuyou, Zhang Hao.
Research and diagnosis and treatment status of primary esophageal small cell carcinoma.
Esophageal Diseases, 2020, 2(1): 8-12.
[3]Wu Han, Gao Sheqian.
Clinical analysis of 48 cases of primary small cell carcinoma of the esophagus.
Esophageal Diseases, 2020, 2(2):141-145.
[4] Hou Honglin, Nie Caiyun, Wang Maoxun, Cao Liang, Lu Huifang, Chen Xiaobing.
Primary Analysis of the clinical characteristics of 82 cases of small cell carcinoma of the esophagus.
Chinese Journal of Medical Frontiers (Electronic Edition), 2020,12(3):72-77.
[5] Xia Yimaldan Ibrahim, Song Peng, Gao Shugeng.
Original Treatment and prognostic analysis of primary small cell carcinoma of the esophagus.
Chinese Journal of Oncology, 2020, 42(8): 670-675.
Clinically, most of the patients with huge abdominal masses we see are often caused by delays in treatment, and today I want to share with you a case.
It took only two weeks for the mass to appear to fill the liver.
…What kind of disease is it, and it progresses so fast? A middle-aged man came to the Gastroenterology Department with a huge mass in his abdomen.
.
.
the man had a pale yellow face and was weak all over.
On physical examination, he found that there was a huge mass on his abdomen, the texture was hard, like an iron pan buckled in his abdominal cavity.
Such a hard mass is almost always caused by malignant tumors.
We asked the patient, “How long has this mass appeared, why not come to the hospital earlier?” The patient said, “The appearance of this mass is only two weeks, the mass grows very fast, and the belly is difficult to distend.
Eat, so come and see the doctor as soon as possible.
"Such a big lump has grown in two weeks? Did the patient make a mistake? Asking the patient and family members carefully, they all indicated that the mass did indeed grow out within two weeks.
A CT scan of the abdomen in the outer hospital indicated that the mass was actually an enlarged liver, which was suspected to be liver metastatic cancer.
We first did a contrast-enhanced ultrasound and found that it was indeed liver metastatic cancer.
Since the patient did not provide other uncomfortable symptoms, we performed a liver biopsy while making an appointment with enhanced CT to look for the primary tumor.
AB Figure 1: Chest enhanced CT image; A.
Venous phase; B.
Arterial phase AB Figure 2: Abdominal enhanced CT image; A.
Arterial phase; B.
The results of enhanced CT in the portal phase found that the esophagus occupied space and multiple liver metastases . The pathological results of the liver biopsy suggest that it is a malignant tumor, which looks like a small cell carcinoma, and needs to be further confirmed by immunohistochemistry.
Combined with the results of multiple examinations, the maze finally revealed that the results of immunohistochemistry were consistent with the characteristics of small cell carcinoma.
The result of gastroscopy revealed that there was indeed a malignant tumor in the middle part of the esophagus, and the result of pathological examination of the esophagus was also small cell carcinoma.
So far, the mystery is completely solved.
The patient is suffering from a rare esophageal malignant tumor with a high degree of malignancy, primary esophageal small cell carcinoma (PESC).
Small cell carcinoma is a highly malignant tumor that usually occurs in the lung.
Small cell carcinoma outside the lung is relatively rare, accounting for only 2.
5% to 4.
1% of small cell carcinoma.
The esophagus is a common occurrence of small cell carcinoma outside the lung.
Location.
PESC is a poorly differentiated esophageal neuroendocrine tumor, a rare tumor of the esophagus, accounting for only 0.
4% to 2.
8% of esophageal cancer, its malignant degree is high, and the 5-year survival rate is extremely low.
Figure 3: NSE results of patients.
PESC patients are mostly middle-aged and elderly people between 50 and 70 years old, and there are more men than women.
Its clinical manifestations are similar to other types of esophageal cancer, and carcinoid syndromes may occur, such as flushing, edema, diarrhea, cramping abdominal pain, etc.
, and blood test NSE is elevated.
Our patient is a 57-year-old middle-aged male with no symptoms of carcinoid syndrome.
The tumor series showed a significant increase in NSE.
Figure 4: Results of other tumor series of patients.
There are two methods for PESC staging.
One is the TNM clinical staging of esophageal cancer, and the other is based on the standard staging method of the American Veterans Hospital and the International Association for Lung Cancer Research, which is divided into limited stages.
(Limited disease, LD) and extensive disease (ED), LD refers to no lymph node metastasis or only regional lymph node metastasis, the disease is limited to the esophagus and surrounding tissues; ED refers to the disease with distant lymph nodes or distant organs Transfer.
The most common metastatic site of PESC is the liver, followed by lung metastasis and bone metastasis.
Our patient came to see a doctor with symptoms caused by compression of abdominal organs caused by rapid liver metastasis.
PESC is very similar to lung small cell carcinoma under a light microscope.
The tumor is composed of small anaplastic cells, the size is similar to small lymphocytes, the division image is easy to see, and the cytoplasm is very small.
The immunophenotype of PESC presents dual features of epithelial and neuroendocrine.
According to the 2010 World Health Organization (WHO) diagnostic criteria for gastrointestinal neuroendocrine tumors, the diagnosis of PESC must meet the following four points: ①The morphology and structure of tumor cells under HE staining conform to the characteristics of small cell carcinoma; ②The Ki67 positive index is greater than 20% Or mitotic images greater than 20/high power field; ③Immunohistochemical detection of neuroendocrine markers, such as Syn, CgA, CD56, NSE, etc.
, at least one must be positive; ④Exclude neuroendocrine cancer in other parts.
Our patients all meet these four diagnostic criteria.
Currently, surgery is the first choice for limited-stage PESC, and the principles of surgery are the same as other esophageal tumors.
For patients with extensive stages of distant metastasis, the combined treatment effect of chemotherapy and radiotherapy is significantly better than simple treatment.
The combined use of endocrine therapy and targeted therapy can significantly prolong the survival time of limited-stage patients.
AB Figure 5: The pathological results of the patient’s liver biopsy with HE staining A.
x20 times B.
x40 times AB Figure 6: The patient’s esophageal tumor Syn immunohistochemistry report; A.
x20 times; B.
x40 times It is a pity, our patient It is a patient with extensive liver metastasis, and the liver is full of metastatic cancers.
The liver function is extremely poor.
It is unable to perform surgery, and cannot tolerate such active treatment methods as chemotherapy, radiotherapy and targeted therapy.
It can only be used Some drugs are used to relieve the suffering of patients.
Faced with such patients, our doctor is both distressed and helpless.
Reference materials: [1]Zhu Y,Qiu B,Liu H,et al.
Primary small cell carcinoma of the esophagus:review of 64 cases from a single institution.
Dis Esophagus.
2014;27(2):152-158.
[ 2] Wu Xiao, Yang Haijun, Gao Sheqian, Zhou Fuyou, Zhang Hao.
Research and diagnosis and treatment status of primary esophageal small cell carcinoma.
Esophageal Diseases, 2020, 2(1): 8-12.
[3]Wu Han, Gao Sheqian.
Clinical analysis of 48 cases of primary small cell carcinoma of the esophagus.
Esophageal Diseases, 2020, 2(2):141-145.
[4] Hou Honglin, Nie Caiyun, Wang Maoxun, Cao Liang, Lu Huifang, Chen Xiaobing.
Primary Analysis of the clinical characteristics of 82 cases of small cell carcinoma of the esophagus.
Chinese Journal of Medical Frontiers (Electronic Edition), 2020,12(3):72-77.
[5] Xia Yimaldan Ibrahim, Song Peng, Gao Shugeng.
Original Treatment and prognostic analysis of primary small cell carcinoma of the esophagus.
Chinese Journal of Oncology, 2020, 42(8): 670-675.
