Primary Squamous Cell Carcinoma of the Remnant Stomach after Subtotal Gastrectomy

Rare epithelial gastric cancers: a review of the current treatment knowledge

Gastric cancer (GC), one of the tumours with the highest mortality worldwide, is not a homogeneous disease, showing different features according to location, macroscopic aspect, histotype and molecular alterations. Adenocarcinoma is the most frequent epithelial GC (95%), the remaining 5% comprising rare epithelial tumours with their peculiarities, behaviour and incidence <6 cases/100,000/year. Due to the low number of cases, many aspects must be elucidated in this context. In this narrative review, we highlight the importance of a better understanding of rare GCs to personalize the cures in the light of the precision medicine concept. Our main aim is to translate the scarce evidence from the literature into daily clinical practice, never forgetting that all the clinicians dedicated to rare GCs should encourage such patients' enrolment in clinical trials and promote international collaborations. Hence, we focused on the treatment of the following rare GCs: rare gastric adenocarcinomas (hepatoid adenocarcinoma, medullary carcinoma with lymphoid stroma, Paneth cell carcinoma and Salivary Gland carcinoma); squamous cell carcinoma; adenosquamous carcinoma; neuroendocrine gastric neoplasms; gastroblastoma.

Squamous cell carcinoma of the stomach: focus on a heterogeneous disease at diagnosis. Case report and literature review

Primary squamous cell carcinoma (SCC) can originate in different parts of the body, including the head, neck, lung, bronchus, cervix uteri, esophagus, and cardia, and subsequently metastasize to the stomach. Primary gastric squamous cell carcinoma (GSCC) is a rare disease. To better understand GSCC, we present the case of a 72-year-old woman with a primary GSCC. A chest and abdominal CT scan highlighted a 36×26 mm mass with a 41 mm longitudinal diameter, which included the origin of the celiac tripod. The disease appeared to originate exophytically from the gastric wall. An ultrasound-endoscopy showed a hypoechoic formation with not well-defined margins measuring 40×30 mm involving the origin of the celiac tripod, about 10 mm from the gastric wall. An endoscopic fine-needle aspiration showed a poorly differentiated carcinoma. A PET/CT scan showed a hyperaccumulation of the known expansive formation at the celiac tripod (SUV 11.9) without specific cleavage planes from the stomach. A gastroscopy showed a regular esophagus and an absence of gastric protruding lesions. In the subcardial area, on the posterior wall, there was a slightly raised sub-centimetric area covered by bleeding mucosa where the biopsy had been performed. The pathological report showed chronic gastritis. An eco-endoscopy confirmed a hypoechoic neoformation measuring 30×40 mm that appeared to originate from the muscular layer of the gastric wall. The biopsy report was positive for broad-spectrum cytokeratins (AE1/AE3), CK5/6/7, p40, p63 and negative for CK20, PAS, TTF-1, anti-smooth muscle actin, CD45 (LCA), ERG, and S100. The clinical picture suggested poorly differentiated carcinoma with squamous differentiation. We analyzed the main classifications of GSCC cases and compared their characteristics. It is clear that to have an appropriate definition of GSCC, well-defined diagnostic criteria are needed. Currently, there is no consensus. For practical purposes, it would be better to include a panel of CK and p40 to distinguish GSCC from adenocarcinoma. A GSCC outside the mucosa is not rare and could be a true entity.

Gastric squamous cell carcinoma: A rare malignancy, literature review and management recommendations (Review)

Gastric cancer serves a major role in the global cancer burden, being the fourth most frequent cause of mortality among all types of cancer. Gastric squamous cell carcinoma (GSCC) is a rare histological variant accounting for 0.04-0.5% of all gastric cancer cases. Diagnostic work-up of GSCC is essential and involves multiple criteria: i) Tumour not located in the cardia, ii) no oesophageal extension of the tumour, and iii) no evidence of SCC in any other part of the body. Little is known about this rare variant in terms of pathogenesis, risk factors or evolution. Consequently, neither the European Society of Medical Oncology nor the National Comprehensive Cancer Network societies have published recommendations for GSCC. The aim of the present review is to provide an in-depth analysis of the current literature on this pathology, from pathophysiological hypothesis and clinical presentation to diagnostic work-up and treatment trends, in order to establish a possible management algorithm.

Metachronous squamous cell carcinoma of pancreas and stomach in an elderly female patient: A case report

BACKGROUND

Squamous cell carcinoma (SCC) in pancreas and stomach is a rare histologic subtype with aggressive behavior, poor prognosis, and no standardized therapy. Pancreatic SCC or gastric SCC has been previously reported. However, case of SCC occurring in both the pancreas and the stomach has not been reported yet.

CASE SUMMARY

A 75-year-old female with prior history of hypertension and diabetes mellitus visited our hospital with complaint of abdominal pain that started three months ago. Computed tomography (CT) scan of the abdomen showed 3.3 cm mass at the distal pancreas. She received surgical resection which was histologically found to be SCC of the pancreas with clear resection margins. After she was discharged, she no longer visited the hospital. Three years later, she was referred to our hospital after showing abnormal findings on a gastroscopy performed at another hospital. Gastroscopy revealed a single, 2cm sized, ill-defined irregular flat and hyperemic mass at high body. Histologic finding of the mass was SCC. CT scan and positive emission tomography CT showed metastatic lesions to the liver and the peritoneum. She received combination chemotherapy with capecitabine and oxaliplatin. However, she passed away 6 mo after diagnosis of gastric SCC.

CONCLUSION

To the best of our knowledge, this is the first case of metachronous SCC of stomach occurring after diagnosis of pancreatic SCC.

Primary gastric squamous cell carcinoma with a bilio-gastric fistula and Krukenberg syndrome

Primary squamous cell carcinoma of the stomach is a rare type of gastric malignancies. Diagnosis criteria are well defined but diagnosis is generally late being made at an advanced stage with metastases explaining its poor diagnosis.

Primary gastric squamous cell carcinoma presenting as a large submucosal mass: A case report and literature review

RATIONALE

Primary gastric squamous cell carcinoma (SCC) is rarely encountered clinically. SCC, which presents as a submucosal tumor, is even rarer. Without the support of pathological evidence, it is difficult to make a correct preoperative diagnosis. Due to limited clinical data, the pathogenesis and treatment of gastric SCC remain unclear.

PATIENT CONCERNS

A 69-year-old man was admitted to our hospital with unexplained weight loss. Endoscopy revealed a submucosal mass without any ulcer on its surface located on the body of the stomach. The results of 2 gastroscopic mucosal biopsies were chronic inflammation.

DIAGNOSES

The clinical diagnosis by computed tomography (CT) and gastroscopy was gastrointestinal stromal tumor (GIST) preoperatively. The postoperative pathological examination demonstrated this tumor as moderately differentiated SCC.

INTERVENTIONS

Total gastrectomy, distal pancreatectomy, and splenectomy were performed.

OUTCOMES

The patient was discharged 7 days after the surgery without any complications. The follow-up CT scan showed no evidence of metastatic disease 6 months after surgery.

LESSONS

Large primary gastric SCC could present as a submucosal mass. Gastroscopic mucosal biopsy may not be able to get tumor tissue due to inflammatory reaction.

A type of neoplasia deadlier than gastric adenocarcinoma? Report of a case of primary gastric squamous cell carcinoma

Background

Primary gastric squamous cell carcinoma is an extremely rare malignancy with few case reports reported so far in the current medical literature. Its incidence varies between 0.04 and 0.07% of all gastric malignancies with a male predominance in the sixth decade of life. It has been found that this type of malignancy has a more aggressive behavior and associated poorer prognosis, when compared to gastric adenocarcinoma. Thus, the most appropriate management of this kind of neoplasia is still debatable due to the small number of reported cases.

Case presentation

We report the case of a 66-year-old man who underwent total gastrectomy with D2 lymphadenectomy for an ulcerative lesion in the fundus of the stomach that turned out to be primary gastric squamous cell carcinoma.

Conclusions

Upon confirmation of this specific malignancy, the affected patients should be enrolled in strict follow-up protocols after curative surgery, since the risk for metastasis is high. Physicians should maintain high clinical suspicion in order to diagnose these tumors at an early stage, along with the need to rule out any other possible primary sites of squamous malignancy.

Primary Gastric Squamous Cell Carcinoma

Primary gastric squamous cell carcinoma (PGSCC) is an extremely rare cause of gastric malignancy.

We present a 66-year-old man with a past medical history of stage I left palpebral marginal zone lymphoma status post radiation. The patient was complaining of a two-year history of bloating and early satiety. An upper endoscopy was performed, showing a 2.5 cm polypoid lesion at proximal corpus; however, the cardia and esophagus were normal. Biopsies were positive for gastric squamous cell carcinoma. He underwent partial gastrectomy and was referred to oncology for treatment.

In 2011, the Japanese Gastric Cancer Association proposed diagnostic criteria for the diagnosis of PGSCC. The clinical presentation of this malignancy does not differentiate from that of other types of gastric tumors. We report this case to highlight squamous cell carcinoma as a cause of primary gastric cancer. Gastroenterologists should be aware of this entity to facilitate prompt referral to specialized centers, where surgical resection can be done.

Neuroendocrine carcinoma of the gastric stump: A case report and literature review

We herein report a case of neuroendocrine carcinoma of the gastric stump found 47 years after Billroth II gastric resection for a benign gastric ulcer. A 74-year-old man was referred to another hospital with melena. Endoscopic examination revealed a localized ulcerative lesion at the gastrojejunal anastomosis. The diagnosis by endoscopic biopsy was neuroendocrine carcinoma. A total gastrectomy of the remnant stomach with D2 lymphadenectomy was performed at our hospital. The lesion invaded the subserosa, and metastasis was found in two of nine the lymph nodes retrieved. The lesion was positive for synaptophysin and chromogranin A, and the Ki-67 labeling index was 60%. The diagnosis of neuroendocrine carcinoma of the gastric stump was confirmed using World Health Organization 2010 criteria. Subsequently, the patient underwent one course of adjuvant chemotherapy with the etoposide plus cisplatin (EP) regimen; however, treatment was discontinued due to grade 3 myelosuppression. The patient showed lymph node metastasis in the region around the gastrojejunal anastomosis in the abdominal cavity 7 mo post-surgery. He then underwent radiotherapy and platinum-based combination chemotherapy; however, the disease progressed and liver recurrence was observed on follow-up computed tomography at 16 mo post-surgery. The patient then received chemotherapy with regimens used for the treatment of small cell lung cancer in first- and second-line settings. The patient died of disease progression 31 months after surgery.

Poorer prognosis in patients with advanced gastric squamous cell carcinoma compared with adenocarcinoma of the stomach: Case report

RATIONALE

Primary squamous cell carcinoma (SCC) of the stomach is a rare disease. The pathogenesis and prognosis of advanced SCC remains to be elucidated. The aim of the current study was to investigate the prognosis of recurrent or metastatic SCC of the stomach.

PATIENT CONCERNS

A retrospective study examined the clinical characteristics and survival outcomes of 14 patients diagnosed with recurrent or metastatic SCC of the stomach, including 7 patients followed up in the hospital and 7 patients selected from the PubMed and Chinese National Knowledge Infrastructure (CNKI) database with meta-analysis between January 2003 and January 2016.

DIAGNOSES

All patients meet the following diagnoses criteria: histological diagnosis of gastric squamous cell carcinoma; the tumor must not be located in the cardia area or extend into the esophagus; presence of local relapse or distant metastases of gastric SCC in computed tomography (CT) images; and no evidence of secondary SCC in the body. Clinical pathological data and follow-up data were obtained from the medical record or case report of each patient.

INTERVENTIONS

Palliative chemotherapy was administered in 14 patients diagnosed with recurrent or metastatic gastric SCC.

OUTCOMES

The median age of 14 patients (10 males and 4 females) was 61 years old (range, 28-76). In total, 57% (8/14 cases) of tumors were located on the lesser curvature side of the stomach and 64% (9/14 cases) of metastatic sites were identified in the liver. All patients received systemic chemotherapy, and their median survival was 7.0 months (range, 2.0-22.3 months).

LESSONS

The median survival of patients with advanced gastric SCC was shorter than the median survival (11 months) of advanced gastric adenocarcinoma, suggesting that advanced gastric SCC may have a poorer prognosis compared with adenocarcinoma of the stomach in recurrent or metastatic stage.

Primary squamous cell carcinoma of the stomach: A report of three cases and literature review

Primary squamous cell carcinoma of the stomach is rare, and it is found mainly in men beyond 60 years old. The upper stomach is always involved. About 100 cases have been reported throughout the world. The etiology and pathogenesis are unclear. Compared with adenocarcinoma of the stomach, primary squamous cell carcinoma of the stomach has no special clinical manifestation. The diagnosis depends on histopathology. Surgery is the preferred therapy, and there is still controversy over the prognosis. Here we report three cases of primary squamous cell carcinoma of the stomach and performed a literature review to summarize its clinical characteristics, therapy and prognosis.