Unusual or Uncommon Histology of Gastric Cancer

Long-term remission of microsatellite instability-high adenosquamous carcinoma in gastric antrum: a case report

Background

Gastric adenosquamous carcinoma (ASC) is an exceedingly rare neoplasm. Its infrequent occurrence has resulted in sparse literature on its diagnosis and management, presenting considerable challenges for clinical practice.

Case presentation

A 70-year-old male presented with epigastric pain and, upon gastroscopy and CT imaging, was found to have a mass in the gastric antrum. Histopathological analysis confirmed the diagnosis of adenosquamous carcinoma. Immunohistochemical staining revealed a loss of PMS2 and MLH-1 expression, while molecular analysis confirmed MLH-1 methylation, suggesting a microsatellite instability-high (MSI-H) phenotype. The PD-L1 combined positive score (CPS) was remarkably elevated at 80. Postoperatively, the patient received six cycles of oxaliplatin in conjunction with PD-1 inhibitor therapy. At the one-year follow-up, the patient remained in long-term remission, with no evidence of recurrence.

Conclusion

This case underscores the potential efficacy of integrating surgery, chemotherapy, and immunotherapy in managing gastric ASC, particularly in the context of MSI-H and elevated PD-L1 expression. It further emphasizes the critical role of comprehensive molecular profiling in guiding personalized therapeutic strategies for such rare malignancies. Further research and additional case reports are imperative to establish optimal management protocols for gastric ASC and to enhance long-term outcomes.

Navigating the complex landscape of crawling-type gastric adenocarcinomas: Insights and implications for clinical practice

In this editorial, we comment on an article by Xu et al. This article describes a case of crawling-type gastric adenocarcinoma (CRA) distinguished by its rare occurrence and diagnostic complexity. We reviewed the detailed case-report findings showcasing clinical, pathological, and molecular characteristics of CRA that shed light on its elusive nature and challenges for early detection and treatment. This case underscored the significance of advanced diagnostic tools such as endoscopic submucosal dissection. Emphasis was placed on the molecular peculiarities of CRA, including the higher mutation rates of genes such as TP53 and RHOA and the notable absence of HER2 amplification, differentiating it from more conventional forms of gastric adenocarcinoma. In this editorial, we advocate for a multidisciplinary approach to effectively manage this rare subtype and highlight the necessity for precision in both diagnostic and therapeutic strategies. Moreover, a heightened awareness urging the adoption of advanced diagnostic techniques and collaborative approaches is necessary among clinicians and researchers. We aim to contribute to the ongoing discourse in gastrointestinal oncology, emphasizing the importance of recognizing and addressing the complexities associated with rare cancer subtypes such as CRA.

Role of ursolic acid in preventing gastrointestinal cancer: recent trends and future perspectives

Gastrointestinal malignancies are one of the major worldwide health concerns. In the present review, we have assessed the plausible therapeutic implication of Ursolic Acid (UA) against gastrointestinal cancer. By modulating several signaling pathways critical in cancer development, UA could offer anti-inflammatory, anti-proliferative, and anti-metastatic properties. However, being of low oral bioavailability and poor permeability, its clinical value is restricted. To deliver and protect the drug, liposomes and polymer micelles are two UA nanoformulations that can effectively increase medicine stability. The use of UA for treating cancers is safe and appropriate with low toxicity characteristics and a predictable pharmacokinetic profile. Although the bioavailability of UA is limited, its nanoformulations could emerge as an alternative to enhance its efficacy in treating GI cancers. Further optimization and validation in the clinical trials are necessary. The combination of molecular profiling with nanoparticle-based drug delivery technologies holds the potential for bringing UA to maximum efficacy, looking for good prospects with GI cancer treatment.

Gastric Adenocarcinoma With Unusual Clear Tubulopapillary Morphology: A Case Report

Gastric clear cell adenocarcinoma is an extremely rare variant of papillary adenocarcinoma of the stomach. It is associated with a poor prognosis due to its frequent lymphovascular invasion and also its higher risk of recurrence. It is characterized morphologically by a clear appearance of tumor cells, which can be easily confused with a metastasis of a clear cell carcinoma, particularly of renal origin. Very few cases have been previously reported in the literature, which makes it a very poorly known variant. Here, we report the case of a 64-year-old patient who presented with a polypoid lesion in the pylorus, revealed by epigastric pain and chronic vomiting. Histological analysis showed a gastric clear cell adenocarcinoma with a tubulopapillary architecture. Immunohistochemical examination excluded a metastasis of renal origin. Through this case report, we highlight the importance of recognizing such an uncommon and unusual variant of gastric adenocarcinoma, to prevent any potential misdiagnosis.