2024 Volume 57 Issue 8 Pages 374-383
A 59-year-old man underwent upper gastrointestinal endoscopy that revealed a semi-peripheral type 2 tumor in the lower thoracic Barrett’s esophagus. The patient was diagnosed with a mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) based on biopsy, which indicated a combination of poorly differentiated adenocarcinoma and neuroendocrine tumor. Subsequently, he underwent subtotal esophagectomy. Histopathological examination showed a mixture of poorly differentiated adenocarcinoma and G2 equivalent neuroendocrine neoplasm, with a discernible transition zone between the two components. Regional lymph node metastasis was observed, leading to introduction of CapeOX therapy, mirroring the approach used for poorly differentiated gastric adenocarcinoma. The patient remained recurrence-free 30 months after surgery, despite discontinuation of adjuvant chemotherapy after the first course because of adverse events. Barrett’s esophageal adenocarcinoma is proposed as the precursor of MiNEN. For treatment of esophageal MiNEN, besides surgical resection, it is crucial to identify the more invasive component before chemotherapy and select a regimen based on the characteristics of the predominant component.
