Akademik Veri Yönetim Sistemi
12th International Gastrointestinal Cancers Conference, İstanbul, Türkiye, 1 - 04 Aralık 2022, ss.13-14
Introduction: Gastric squamous cell carcinoma (SCC) that is a rare cancer accounts for 0.04-0.07% of all gastric malignant epithelial tumors. It was described for the first time in 1895 by Rörig et al. Case: A 78-year-old woman presented with weight loss, nausea, vomiting for 4 months. She has hypothyroidisim taking with levothyroxin and non-smoker.There was no family history.The patient's endoscopy revealed gastric mass extending into the duodenum and causing gastric outlet stenosis. Endoscopic biopsy was reported as gastric squamous cell cancer. Biopsy showed that Ki-67 is %90 positive and immunohistochemical study showed positivity for p40 and CK 5/6 and negativity for CK7. She had also anemia (Hb: 8,5 g/dl). Routine biochemical values were normal and CEA was 1,4 ng/mL. PET-CT scan showed that pathological FDG uptake was observed only in primary tumor region of the stomach(suv-max:25)(Figure-1). The patient had whipple surgery. Pathology revealed that tumor was 4 cm, invaded the pancreatic parenchyma and infiltrated duodenum serosa. There are perineural and lenfovascular invasion. No positive lymph nodes in surgical specimen. Adjuvant KAPEOX was started. After 4 cycle KAPEOX, oxaliplatin was discontinued due to grade 3 neutropenia and only capecitabine was given for 1 more cycle. PET-CT scan after chemotherapy showed no pathological FDG uptake. She was operated for ileus 7 months after the end of adjuvant chemotherapy. The pathology of the implants on the small bowel mesentery was reported as poorly differentiated adenocarcinoma.On immunohistochemical testing, CK 7 and MOC1 were positive; synaptophysin, chromogranin, p40, CK5/6, GATA,TTF-1 were negative. This pathology was evaluated together with the first pathology. In the initial pathology; sparse, scattered and approximately %5 poorly differentiated adenocarcinoma foci were observed among the extensive squamous cell carcinoma areas. Therefore, this situation was accepted as a recurrence.The patient was subsequently hospitalized in the intensive care unit due to intra-abdominal sepsis and the patient’s treatment continues. Discussion: Gastric SCC carcinogenesis can be related to pluripotent stem cells displaying squamous metaplasia or ectopic squamous nests. Mori et al identified an adenomatous component during the detailed histologic study of 3 cases of SCC of the stomach. This finding led them to the hypothesis that the precursor metaplastic squamous cell lesions would develop from an adenocarcinoma. In our case, the adenocarcinoma recurrence may have resulted from a few adenocarcinoma foci at the time of diagnosis. The gastric squamous cell carcinoma has a locally aggressive behavior and a poor prognosis due to late diagnosis and frequent lymphovascular serosal involvement.In conclusion, gastric SCC patients should be enrolled in strict follow-up protocols because of poor prognosis and recurrence risk even in different pathology.
Keywords: stomach, squamous cell carcinoma, gastric