P C Munipalle, M Little, P A Davis, D Wilson, J Dean, Y K S Viswanath
South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
Most of the SCC lesions seen in stomach have components of adenocarcinoma – primary gastric squamous cell carcinoma (SCC) is very rare. We recently treated a patient with primary SCC. We present the case followed by review of literature.
A 73 year old previously fit male presented to the acute medicine with melaena and rapidly dropping Haemoglobin levels. He underwent multiple blood transfusions followed by urgent endoscopy, which showed pre-pyloric mass with stigmata of recent bleeding. CT scan suggested a mass in the pancreatic body and distal stomach, likely to be a gastrointestinal stromal tumour (GIST). He was transferred to our tertiary upper GI referral centre for further management. After resuscitation he underwent emergency laparoscopic assisted distal gastrectomy, gastro-jejunostomy and feeding jejunostomy.
Histological analysis of the specimen showed well differentiated SCC breaching serosal surface, positive for cytokeratins AE1/AE3, CK5 and p63; negative for CD117, CD34, TTF1 and cytokeratins (CK7 and CK20). The final staging was pT4 pN0 pMx R1. Despite thorough investigations no evidence of a primary SCC elsewhere was found. The patient was offered palliative adjuvant chemotherapy.
(Endoscopic pictures shall be presented on Poster)
Less than 100 cases have been so far reported. Three criteria were suggested in literature to identify primary gastric SCC: absence of tumour in the cardia, non-involvement of oesophagus and no other primary SCC elsewhere. The exact origin of SCC de novo is not clear. In majority of the cases the disease is at an advanced stage at diagnosis(as happened in our case), and hence prognosis is poorer compared to other types of cancers of stomach. Chemotherapy with a combination of Adriamycin, 5 FU, Mitomycin, leucovorin, Etoposide and Cisplatin were tried as adjuvant therapies. Early identification of this tumour is essential for optimum management.
Session: Poster Presentation
Program Number: P228