Endoscopic mucosal resection of early stage colon neuroendocrine carcinoma

Abstract

SUMMARYEarly stage colorectal neuroendocrine carcinoma is rare. A small colon tumour was found in a 56-year-old man during diagnostic colonoscopy performed after a positive faecal occult blood test, and he was referred for treatment. A slightly reddish superficial elevated lesion with a shallow depression 10 mm in size was found in the transverse colon. Magnifying narrow-band imaging revealed disrupted irregular microvessels and the absence of a surface pattern in the depressed area. En bloc endoscopic mucosal resection (EMR) of the tumour was undertaken. The tumour was positive for chromogranin A and synaptophysin, and had a mitotic rate of >20/10 high-power fields and a Ki-67 proliferative index of >50%; it was diagnosed as a neuroendocrine carcinoma. The tumour minimally invaded the submucosa (300 μm) without lymphovascular involvement. The patient was followed up carefully, and at 1 year after EMR, no recurrence was found using colonoscopy and CT scans. BACKGROUND

Comparative evaluation of the diagnostic value of biopsy and NBI endoscopy in patients with cancer of the hypopharynx and larynx

“…This is an extremely rare tumour, accounting for less than 1% of all laryngeal cancers [21]. One description of the appearance of the neuroendocrine tumour seen in NBI is given in the literature, concerning the lesion localised in the intestinal lumen [22] and in the area of the head and neck [19]. The authors have not observed any characteristic vascularisation that confirms the malignant nature of the lesion.…”

Narrow band imaging for head and neck malignancies: Lessons learned from mistakes

“…Yamasaki et al described the NBI pattern of neuroendocrine carcinoma of the colon as disrupted irregular microvessels and absence of a surface pattern in the depressed area. Laryngeal neuroendocrine carcinoma is a rare malignancy, accounting for <1% of all laryngeal neoplasms, and, so far, no NBI findings have been published.…”

European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours

“…12 Several authors have described successful endoscopic excision of colonic NET, and in the main use of endoscopic resection techniques are reserved for smaller lesions (often <10 mm). [24][25][26] Techniques such as en bloc endoscopic submucosal dissection (ESD) resections or using devices to achieve full thickness resection have also been described, but only limited data are available. 27,28 Recommendation: Endoscopic resection may be appropriate in selected cases for small (usually 10 mm of less) colonic NET G1.…”

“…Several authors have described successful endoscopic excision of colonic NET, and in the main use of endoscopic resection techniques are reserved for smaller lesions (often <10 mm) 24–26 …”