LETTERS TO THE EDITOR

 

A rectal neuroendocrine neoplasm

Neoplasia neuroendocrina rectal

 

 

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Key words: Carcinoid. Colorectal neuroendocrine carcinoma. Endoscopic ultrasound.

Palabras clave: Carcinoide. Carcinoma neuroendocrino colorrectal. Ecoendoscopia.

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Dear Editor,

We have attentively read the article by Benito et al. (1). It is true that colorectal neuroendocrine carcinoma is relatively rare (1). In 2008, from the five reported surgical cases collected over a six year period (involving the rectum, sigmoid colon and cecum), two were disseminated lesions (2).

In 2010, (3) we reported 13 cases of carcinoids of the rectum and colon collected over a 16 year period; subsequently, this series was updated in 2017.

Over a 23 year period (1994-2016) we have collected 22 colorectal neuroendocrine tumor cases and most of them were carcinoids. Only one involved the rectum (25 mm) with liver metastases, and was labeled as a neuroendocrine carcinoma.

The incidence of gastric and rectal carcinoids is increasing. This is probably due to endoscopic screening (4). The prognosis is primarily dependent upon tumor size, aggressiveness (pathology, Ki-67), metastatic disease and stage. However, neuroendocrine carcinoma usually behaves as an adenocarcinoma (2).

Survival at five years with distant involvement is around 15-30% (4). Lesions larger than 2 cm are managed with surgery and/or chemotherapy, whereas those smaller than 1 cm are treated with local therapy, primarily endoscopic excision. The management and treatment for tumors of 1-2 cm in size is controversial, although most benefit from local therapy such as polypectomy in all its variants, mucosectomy and bands (5).

 

Modesto J. Varas-Lorenzo and Fernando Muñoz-Agel
Digestive Endoscopy Unit. CM Teknon Quirón Salud.
Barcelona, Spain

 

References

1. De Benito Sanz M, Santos Fernández J, Núñez Rodríguez MH. Neoplasia neuroendocrina rectal, un tumor poco habitual. Rev Esp Enferm Dig 2017;109:79-80.         [ Links ]

2. Vilallonga R, Espín E, López Cano M, et al. Neuroendocrine carcinomas of the colon and rectum: A unit's experience over six years. Rev Esp Enferm Dig 2008;100(1):11-6.         [ Links ]

3. Varas Lorenzo MJ, Muñoz-Agel F, Espinós Pérez JC, et al. Tumores carcinoides digestivos. Rev Esp Enferm Dig 2010;102:533-7. DOI: 10.4321/S1130-01082010000900004.         [ Links ]

4. Scherübl H. Rectal carcinoids are on the rise: Early detection by screening endoscopy. Endoscopy 2009;41:162-5. DOI: 10.1055/s-0028-1119456.         [ Links ]

5. Martínez-Ares D, Souto-Ruzo J, Varas Lorenzo MJ, et al. Endoscopic ultrasound-assisted endoscopic resection of carcinoid tumors of the gastrointestinal tract. Rev Esp Enferm Dig 2004;96:847-55. DOI: 10.4321/S1130-01082004001200005.         [ Links ]