Esophagogastric junctional neuroendocrine tumor with adenocarcinoma: A case report

lNTRODUCTlON

At present, cases of esophageal neuroendocrine tumors (NETs) combined with cardia adenocarcinoma are extremely rare worldwide. The presence of cardia cancer and esophageal NETs (E-NETs) in a single patient has not yet been reported. Herein, we describe such a case for clinical reference.

CASE PRESENTATlON

Chief complaints

A 76-year-old man was hospitalized due to the presence of a cardia mass.

（1）空間分布上，新疆地區多年平均降水量126.8mm，北疆地區多年平均降水量246.2mm，南疆地區多年平均降水量41.5mm，北疆＞全疆＞南疆。

History of present illness

The authors declare that they have no conflicts of interest to disclose.

History of past illness

Zhejiang Provincial Department of Health Clinical Research Application Project, No. 2022KY924; and General Project of Zhejiang Provincial Department of Health, No. 2021KY835.

Personal and family history

Pathology is the gold standard for the diagnosis of NETs. The proliferation activity of tumor cells can be evaluated by the number of mitotic figures or the Ki-67 index. According to the 2019 WHO classification standards, NETs are divided into three grades: G1, G2, and G3. The classification criteria are as follows: G1 is defined as ＜ 2 mitotic cells/10 high-power fields (HPFs), G2 as 2-20 cells/10 HPFs, and G3 as ＞ 20 cells/10 HPFs. The Ki-67 index is classified as follows: G1, ≤ 2%; G2, 3%-20%; and G3, ＞ 20%[8].When the Ki-67 index is inconsistent with the mitotic cell classification, it can instead be classified as high or low. DAXX/ATRX and p53/RB mutations can be used to distinguish G3 NETs from neuroendocrine carcinomas (NECs). According to the guidelines, NETs are ＜ 1 cm in size, are grade G1/G2,have a low metastasis rate (＜ 3%), and do not infiltrate into the muscularis propria (T1 stage). Thus, they are suitable for endoscopic treatment. For tumors or NECs more than 2 cm in diameter, the metastasis rate can reach as high as 60% to 80%, so radical resection is the first choice.

2.1 饑餓對按蚊吸血的影響 稱重法繪制吸血率曲線顯示，饑餓處理能提高按蚊的吸血率，二者差異有統計學意義（P＜0.05）。在吸血5 min時，饑餓組按蚊的吸血率達到21.4%，顯著高于對照組的15.6%。饑餓處理組按蚊經15 min的吸血即可達到最高吸血率（69.5%），而對照組按蚊則需要20 min才能達到最高吸血率（32.5%），見圖1A。目視法繪制結果顯示吸血率的結果與稱重法結果一致，見圖1B。然而對照組和饑餓組按蚊的最大吸血量差異無統計學意義（P＞0.05），平均為1.43 mg/只和1.37 mg/只，見圖1C。

Physical examination

No remarkable characteristics were found during the physical examination.

Laboratory examinations

The laboratory results were all normal.

Imaging examinations

Previous gastroscopy showed a 0-IIa-like lesion of the cardia and chronic atrophic gastritis with erosions. Enhanced computed tomography scan of the full abdomen was performed after hospitalization, which revealed that the local gastric wall of the gastric cardia was slightly thickened, no significantly enlarged lymph node shadow was seen around the cardia, and the rest of the region appeared unchanged (Figures 2-4).

生命科學的發展離不開實驗技術的推動，可以說科學實驗是生命科學奠基之石，科學探究能力也是高中生物學重點培養的核心素養之一。在生物學教學中，實驗教學所占比重與份額在不同中學、不同教師處大相徑庭，甚至有天壤之別。差異形成之原因主要有：教師實驗教學意識差異；學校實驗教學條件差異，如實驗條件差異、課時差異、理念差異。另外，現在的生物學教學中還存在理論課替代實驗課、講實驗替代做實驗等問題。毋庸置疑，相較于理論教學無論是對于學生知識理解，還是學生思維能力、科學意識、實驗能力的提升，實驗教學都略勝一籌，教師要著力提升實驗教學在中學教學結構中的占比。

FlNAL DlAGNOSlS

The final diagnosis was differentiated cardia adenocarcinoma and E-NET (G3).

TREATMENT

Endoscopic submucosal dissection and surgical resection were performed.

OUTCOME AND FOLLOW-UP

The patient was in good general condition without obvious discomfort (Figures 5 and 6).

DlSCUSSlON

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The patient’s personal/family history was unremarkable.

CONCLUSlON

Kong ZZ was involved in writing the article; Zhang L was involved in the conception of the study; all authors read and approved the final manuscript.

FOOTNOTES

A case of cardia adenocarcinoma combined with E-NETs has not yet been reported. In our patient, after timely endoscopic treatment, pathology revealed that the distance between the cardia cancer and the ENETs was small, approximately 3 mm, vascular invasion was observed, and the E-NET was determined to be grade G3. According to the treatment guidelines, after the patient received an explanation of their condition, additional surgical procedures were provided in a timely manner. Complete resection of the lesion significantly improved the patient’s quality of life.

The patient’s medical history was unremarkable.

NENs are a group of highly heterogeneous tumors originating from neuroendocrine cells. They can occur in many parts of the body but are most often found in the digestive system, followed by the lungs.E-NETs are very rare[1], accounting for only 1.4% of all gastrointestinal pancreatic tumors[2] and 0.15%-2.80% of all esophageal tumors[3]. This is due to the poor development of the neuroendocrine system in this area of the body[2]. The incidence rate varies across countries[4]; these tumors are more commonly found in Asian countries than in Western countries[5]. Studies have found that smoking (present in 49%) and drinking (present in 31%) may be a high-risk factor[6,7]. At present, cases of E-NETs combined with cardia adenocarcinoma are extremely rare worldwide, and there are no clinical reports.

Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Previous gastroscopy showed a 0-IIa-like cardia lesions and chronic atrophic gastritis with erosions. The pathological examination revealed the following: Tubular adenoma with high-grade intraepithelial neoplasia; mild chronic atrophic gastritis of the antrum; intestinal metaplasia; andinfection (Figure 1).

The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

在單因素試驗的基礎上，考查鹽酸質量分數、浸提時間、浸提溫度、料液比對刺葡萄皮花青素浸提的影響，進行L9（34）正交試驗。以浸提液的吸光度值為評價指標，確定刺葡萄皮花青素的最優浸提工藝。

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China

Zhen-Zhen Kong 0000-0002-2177-0974; Lu Zhang 0000-0001-7726-4846.

Fan JR

Wang TQ

Fan JR