Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2021; 9(11): 2562-2568
Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2562
Endoscopic diagnosis of early-stage primary esophageal small cell carcinoma: Report of two cases
Li-Mian Er, Yan Ding, Xiao-Fang Sun, Wen-Qian Ma, Li Yuan, Xiu-Li Zheng, Na-Na An, Ming-Li Wu
Li-Mian Er, Wen-Qian Ma, Li Yuan, Xiu-Li Zheng, Na-Na An, Ming-Li Wu, Department of Endoscopy, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Yan Ding, Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Xiao-Fang Sun, Department of Endoscopy, People's Hospital of Xingtai, Xingtai 054000, Hebei Province, China
Author contributions: Er LM wrote the manuscript and performed the treatment; Sun X F diagnosed the patient; Wu ML revised the article; Ding Y contributed to the histopathology and immunohistochemistry; and all other authors reviewed and approved the final manuscript to be published.
Supported by The Key Basic Research Program of Hebei, No. 20150329.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Mian Er, MD, Associate Professor, Department of Endoscopy, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang 050011, Hebei Province, China. hbsyelm@163.com
Received: November 26, 2020
Peer-review started: November 26, 2020
First decision: December 30, 2020
Revised: January 9, 2021
Accepted: January 25, 2021
Article in press: January 25, 2021
Published online: April 16, 2021
Abstract
BACKGROUND

Primary esophageal small cell carcinoma (PESCC) is a highly aggressive malignancy, and its detailed clinical behaviors have remained virtually unknown. Because of the rapid tumor progression, the diagnosis of esophageal small cell carcinoma at early stage is extremely difficult in clinical practice. Currently, only a handful of PESCC cases have been reported.

CASE SUMMARY

Case 1: A 62-year-old man was diagnosed with an esophageal submucosal tumor by endoscopy. Endoscopic ultrasonography showed a 0.8 cm low echo nodule in the muscularis mucosa. As the patient refused to undergo endoscopic resection, neoplasia was detected by endoscopy 1 year later. Case 2: A 68-year-old woman was diagnosed as having an esophageal submucosal tumor by endoscopy at a local hospital. About 2 wk later, we performed endoscopic ultrasonography and found a 1 cm low echo nodule in the muscularis mucosa; the submucosal was thinner than normal but still continuous; mucosal hyperemia and erosion were found on the surface of the tumor. Endoscopic submucosal dissection (ESD) was performed and the histopathological finding showed a small cell carcinoma invading the submucosal layer.

CONCLUSION

Early esophageal small cell carcinoma shows submucosal infiltrating growth with a hypoechoic mass in the muscularis mucosa as diagnosed by endoscopic ultrasonography. It is easily misdiagnosed as submucosal masses. Endoscopic manifestations should be identified and pathological biopsies should be employed. ESD may be performed to provide an opportunity for early treatment of PESCC.

Keywords: Primary esophageal small cell carcinoma, Early stage, Endoscopic submucosal dissection, Endoscopic ultrasonography, Small submucosal masses, Poor prognosis, Case report

Core Tip: Early-stage primary esophageal small cell carcinoma (PESCC) is extremely rare in clinical practice. Here we report two such cases. Endoscopic manifestations of both cases showed a small submucosal mass. Case 1 missed the best time for treatment and neoplasia developed 1 year later; Case 2 was identified with early-stage of PESCC and the tumor was completely resected by endoscopic submucosal dissection.