Esophageal Large Cell Neuroendocrine Carcinoma: An Unique Consult Case from China and Lessons Learned

Case Report
|
Open Access
|
ISSN: 2637-4501

Esophageal Large Cell Neuroendocrine Carcinoma: An Unique Consult Case from China and Lessons Learned

Corresponding Author(s): Gang He
Pennsylvania state university, Hersch, PA, USA.
gang.he2401@gmail.com
He G (2021).
This Article is distributed under the terms of Creative Commons Attribution 4.0 International License

Received	:	Nov 02, 2021
Accepted	:	Dec 08, 2021
Published Online	:	Dec 15, 2021
Journal	:	Annals of Gastroenterology and the Digestive System
Publisher	:	MedDocs Publishers LLC
Online edition	:	http://meddocsonline.org

Cite this article: Lan Z, Wu Q, Zhang YH, He G. Esophageal Large Cell Neuroendocrine Carcinoma: An UniqueConsult Case from China and Lessons Learned. Ann Gastroenterol Dig Syst. 2021; 4(2): 1051.

Background

For years, we have conducted telepathology consultation for cancer patients from China. Major discrepancies in diagnosis were identified in all cases. Herein, we focus on one unique case of esophageal large cell neuroendocrine carcinoma to illustrate differences in pathology practice patterns between American and Chinese pathologists.

Case summary

A 60-year-old Chinese man received an esophagoscopy biopsy and was diagnosed with “esophageal squamous cell carcinoma” at a Chinese municipal hospital. Subsequently he underwent esophagectomy following neochemo-radiation therapy at a top Cancer Hospital in Beijing, with pathology rendering a diagnosis of “adenocarcinoma of esophagus” but no confirming Immunohistochemical Stain (IHC) and no specific pTNM staging in final report. Six months later, he developed pathological fractures and multiple subcutaneous nodules, which were biopsied at a Provincial Cancer Hospital and diagnosed as “neuroendocrine carcinoma, small cell type”. The tumor progressed, and the patient died within three months. Given the dissimilar diagnoses made by three different hospitals, the materials were sent to us by patient’ family for consultation and review.

Results

After reviewing the medical history, reports, and available slides, additional confirmatory IHC stains were performed. We found all three biopsies and surgical specimens were consistent with “a poorly differentiated esophageal large cell neuroendocrine carcinoma”; this diagnosis was also confirmed at Memorial Sloan Kettering Cancer Center. The major diagnostic discrepancies observed between the American and Chinese Hospitals for this case consisted of (1) misinterpretation of the biopsy specimens and IHC stains; (2) oversimplification of the pathology report and absence of pTNM staging; (3) a lack of review of prior medical history/reports as well as a failure of comparison to previous biopsies.

Conclusion

These findings provide guidance on steps needed to improve the pathology care rendered in China and highlight valuable elements of American pathology practice. Key elements include uniform training and evaluation of practicing pathologists, the use of standardized reporting templates inclusive of prognostic indicators, and the value of intra-institutional communication between pathologists.

Variables	March 11 - May 6, 2019	March 11 - May 6, 2020	p-value
Total, n	233	224
Demographics
Male, n (%)	117 (50.2%)	103 (46.0%)	p = 0.365
Female, n (%)	116 (49.8%)	121 (54.0%)	p = 0.365
Mean age, years (SD)	40.8 (16.9)	40.8 (16.3)	p = 0.645
Age range, years	15-92	16-81
Adults, n (%)	228 (97.9%)	223 (99.6%)
Pediatrics, n (%)	5 (2.1%)	1 (0.4%)
Triage vitals
Abnormal triage vitals, n (%)	62 (26.6%)	79 (35.3%)	p = 0.053
Abnormal BP (SBP < 80 mmHg, DBP < 40 mmHg), n (%)	0 (0.0%)	0 (0.0%)
Abnormal HR (> 100 bpm, or < 60 bpm), n (%)	52 (83.9%)	73 (92.4%)
Abnormal temp (>38.0C, or <35.0C)	14 (22.6%)	5 (6.3%)
Abnormal respiratory rate (>24 /min, or < 16/min), n (%)	14 (1.6%)	0 (0.0%)
Abnormal SpO2 (<92%), n (%)	0 (0.0%)	0 (0.0%)
Duration of symptoms perceived by the patients
0 - 72 hours, n (%)	184 (78.6%)	147 (71.0%)
72 - 168 hours, n (%)	27 (11.5%)	39 (18.8%)
> 168 hours, n (%)	17 (7.3%)	17 (8.2%)
Unknown, n (%)	6 (2.6%)	4 (1.9%)
Mean hours (SD)	49.4 (79.6)	52.7 (74.2)	p = 0.646
Minimum hours	1	2
Maximum hours	720	672
Time from triage to operating room
0 - 12 hours, n (%)	144 (66.1%)	153 (74.6%)
12 - 24 hours, n (%)	72 (33.0%)	44 (21.5%)
> 24 hours, n (%)	2 (0.9%)	4 (2.0%)
Unknown, n (%)	0 (0.0%)	4 (2.0%)
Mean hours (SD)	10.3 (5.20)	9.9 (7.13)	p = 0.621
Minimum hours	1	2
Maximum hours	28	72
Preoperating imaging			p = 0.579
Ultrasound, n (%)	64 (27.4%)	63 (28.1%)
CT, n (%)	167 (71.4%)	161 (71.9%)
MRI, n (%)	1 (0.4%)	0 (0.0%)
No imaging, n (%)	1 (0.4%)	0 (0.0%)
Unknown, n (%)	1 (0.4%)	0 (0.0%)
Radiographic diagnosis			p = 0.514
Uncomplicated appendicitis	197 (84.2%)	185 (82.6%)
Complicated appendicitis	35 (15.0%)	39 (17.4%)
Length of Stay
Mean length of stay, days (SD)	1.90 (2.36)	2.22 (2.88)	p = 0.186

	March 11 - May 6, 2019	March 11 - May 6, 2020	p-value
Diagnosis			p = 0.184
Uncomplicated appendicitis, n (%)	166 (71.2%)	146 (65.8%)
Complicated appendicitis, n (%)	66 (28.3%)	76 (34.2%)
Unknown, n (%)	1
Management			p = 0.195
Laparoscopic appendectomy, n (%)	209 (89.3%)	188 (83.9%)
Open appendectomy with McBurney's incision, n (%)	4 (1.7%)	1 (0.4%)
Laparoscopic washout + drain placement without appendectomy, n (%)	0 (0.0%)	1 (0.4%)
Laparoscopic partial cecectomy, n (%)	4 (1.7%)	11 (4.9%)
Ileocolic resection, n (%)	0 (0.0%)	2 (0.9%)
Right hemicolectomy, n (%)	1 (0.4%)	2 (0.9%)
Conversion to laparotomy, n (%)	1 (0.4%)	0 (0.0%)
Antibiotics only, n (%)	6 (2.6%)	10 (4.5%)
Antibiotics + percutaneous drain insertion, n (%)	9 (3.8%)	9 (4.0%)
Intraoperative findings			p = 0.010
Normal appendix, n (%)	9 (4.1%)	1 (0.5%)
Uncomplicated appendicitis, n(%)	157 (72.4%)	145 (70.7%)
Appendicitis with contained perforation, n(%)	14 (6.5%)	6 (2.9%)
Appendicitis with purulent contamination, n (%)	22 (10.1%)	32 (15.6%)
Appendicitis with feculent contamination, n (%)	4 (1.8%)	4 (2.0%)
Necrotic appendix, n (%)	4 (1.8%)	7 (3.4%)
Gangrenous appendix, n (%)	7 (3.2%)	3 (1.5%)
Inflammatorh phlegmon, n (%)	0 (0.0%)	5 (2.4%)
Others, n (%)	0 (0.0%)	2 (1.0%)
Pathology			p = 0.397
Normal appendix, n (%)	6 (2.8%)	2 (1.0%)
Acute appendicitis with no other pathological diagnosis, n (%)	206 (94.5%)	196 (96.1%)
Appendiceal polyp, n (%)	3 (1.4%)	2 (1.0%)
Carcinoid tumor, n (%)	1 (0.5%)	0 (0.0%)
Neuroendocrine tumor, n (%)	2 (0.9%)	1 (0.5%)
Mucinous neoplasm, n (%)	0 (0.0%)	1 (0.5%)
Adenocarcinoma, n (%)	0 (0.0%)	2 (1.0%)

Annals of Gastroenterology and the Digestive System

Esophageal Large Cell Neuroendocrine Carcinoma: An Unique Consult Case from China and Lessons Learned

Background

Case summary

Results

Conclusion

MedDocs Publishers