Esophagogastric junctional neuroendocrine tumor with adenocarcinoma: A case repo

lNTRODUCTlON

At present, cases of esophageal neuroendocrine tumors (NETs) combined with cardia adenocarcinoma are extremely rare worldwide. The presence of cardia cancer and esophageal NETs (E-NETs) in a single patient has not yet been reported. Herein, we describe such a case for clinical reference.

CASE PRESENTATlON

Chief complaints

A 76-year-old man was hospitalized due to the presence of a cardia mass.

（1）空间分布上，新疆地区多年平均降水量126.8mm，北疆地区多年平均降水量246.2mm，南疆地区多年平均降水量41.5mm，北疆＞全疆＞南疆。

History of present illness

The authors declare that they have no conflicts of interest to disclose.

History of past illness

Zhejiang Provincial Department of Health Clinical Research Application Project, No. 2022KY924; and General Project of Zhejiang Provincial Department of Health, No. 2021KY835.

Personal and family history

Pathology is the gold standard for the diagnosis of NETs. The proliferation activity of tumor cells can be evaluated by the number of mitotic figures or the Ki-67 index. According to the 2019 WHO classification standards, NETs are divided into three grades: G1, G2, and G3. The classification criteria are as follows: G1 is defined as ＜ 2 mitotic cells/10 high-power fields (HPFs), G2 as 2-20 cells/10 HPFs, and G3 as ＞ 20 cells/10 HPFs. The Ki-67 index is classified as follows: G1, ≤ 2%; G2, 3%-20%; and G3, ＞ 20%[8].When the Ki-67 index is inconsistent with the mitotic cell classification, it can instead be classified as high or low. DAXX/ATRX and p53/RB mutations can be used to distinguish G3 NETs from neuroendocrine carcinomas (NECs). According to the guidelines, NETs are ＜ 1 cm in size, are grade G1/G2,have a low metastasis rate (＜ 3%), and do not infiltrate into the muscularis propria (T1 stage). Thus, they are suitable for endoscopic treatment. For tumors or NECs more than 2 cm in diameter, the metastasis rate can reach as high as 60% to 80%, so radical resection is the first choice.

2.1 饥饿对按蚊吸血的影响 称重法绘制吸血率曲线显示，饥饿处理能提高按蚊的吸血率，二者差异有统计学意义（P＜0.05）。在吸血5 min时，饥饿组按蚊的吸血率达到21.4%，显著高于对照组的15.6%。饥饿处理组按蚊经15 min的吸血即可达到最高吸血率（69.5%），而对照组按蚊则需要20 min才能达到最高吸血率（32.5%），见图1A。目视法绘制结果显示吸血率的结果与称重法结果一致，见图1B。然而对照组和饥饿组按蚊的最大吸血量差异无统计学意义（P＞0.05），平均为1.43 mg/只和1.37 mg/只，见图1C。

Physical examination

No remarkable characteristics were found during the physical examination.

Laboratory examinations

The laboratory results were all normal.

Imaging examinations

Previous gastroscopy showed a 0-IIa-like lesion of the cardia and chronic atrophic gastritis with erosions. Enhanced computed tomography scan of the full abdomen was performed after hospitalization, which revealed that the local gastric wall of the gastric cardia was slightly thickened, no significantly enlarged lymph node shadow was seen around the cardia, and the rest of the region appeared unchanged (Figures 2-4).

生命科学的发展离不开实验技术的推动，可以说科学实验是生命科学奠基之石，科学探究能力也是高中生物学重点培养的核心素养之一。在生物学教学中，实验教学所占比重与份额在不同中学、不同教师处大相径庭，甚至有天壤之别。差异形成之原因主要有：教师实验教学意识差异；学校实验教学条件差异，如实验条件差异、课时差异、理念差异。另外，现在的生物学教学中还存在理论课替代实验课、讲实验替代做实验等问题。毋庸置疑，相较于理论教学无论是对于学生知识理解，还是学生思维能力、科学意识、实验能力的提升，实验教学都略胜一筹，教师要着力提升实验教学在中学教学结构中的占比。

FlNAL DlAGNOSlS

The final diagnosis was differentiated cardia adenocarcinoma and E-NET (G3).

TREATMENT

Endoscopic submucosal dissection and surgical resection were performed.

OUTCOME AND FOLLOW-UP

The patient was in good general condition without obvious discomfort (Figures 5 and 6).

DlSCUSSlON

引言：促进农村消费升级的金融对策需要从社会、政府、农民等几方面做出共同的改变，能够有效提高农村居民的消费力度和消费范围，确保更多的农村居民能够合理地进行消费规划。

The patient’s personal/family history was unremarkable.

CONCLUSlON

Kong ZZ was involved in writing the article; Zhang L was involved in the conception of the study; all authors read and approved the final manuscript.

FOOTNOTES

A case of cardia adenocarcinoma combined with E-NETs has not yet been reported. In our patient, after timely endoscopic treatment, pathology revealed that the distance between the cardia cancer and the ENETs was small, approximately 3 mm, vascular invasion was observed, and the E-NET was determined to be grade G3. According to the treatment guidelines, after the patient received an explanation of their condition, additional surgical procedures were provided in a timely manner. Complete resection of the lesion significantly improved the patient’s quality of life.

The patient’s medical history was unremarkable.

NENs are a group of highly heterogeneous tumors originating from neuroendocrine cells. They can occur in many parts of the body but are most often found in the digestive system, followed by the lungs.E-NETs are very rare[1], accounting for only 1.4% of all gastrointestinal pancreatic tumors[2] and 0.15%-2.80% of all esophageal tumors[3]. This is due to the poor development of the neuroendocrine system in this area of the body[2]. The incidence rate varies across countries[4]; these tumors are more commonly found in Asian countries than in Western countries[5]. Studies have found that smoking (present in 49%) and drinking (present in 31%) may be a high-risk factor[6,7]. At present, cases of E-NETs combined with cardia adenocarcinoma are extremely rare worldwide, and there are no clinical reports.

Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Previous gastroscopy showed a 0-IIa-like cardia lesions and chronic atrophic gastritis with erosions. The pathological examination revealed the following: Tubular adenoma with high-grade intraepithelial neoplasia; mild chronic atrophic gastritis of the antrum; intestinal metaplasia; andinfection (Figure 1).

The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

在单因素试验的基础上，考查盐酸质量分数、浸提时间、浸提温度、料液比对刺葡萄皮花青素浸提的影响，进行L9（34）正交试验。以浸提液的吸光度值为评价指标，确定刺葡萄皮花青素的最优浸提工艺。

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China

Zhen-Zhen Kong 0000-0002-2177-0974; Lu Zhang 0000-0001-7726-4846.

Fan JR

Wang TQ

Fan JR