Back to Annual Meeting Program

Background: Primary gastric squamous cell carcinoma (PGSCC) is extremely rare, it accounts for 0.2% of all gastric carcinomas with fewer than one hundred cases have been reported in the literature.

Case presentation: We report a case of 70-year-old male who presented with melena and hypotension the same day he was discharged home after undergoing aortic valve replacement. He referred a 15 lb weight loss over few months. His past medical history is significant for smoking (60 pack-year) and aortic stenosis. His physical exam was unremarkable. Esophago-gastro-duodenoscopy (EGD) revealed a five-centimeter ulcerated mass in the fundus of the stomach, 2 cm from gastroesophageal junction without active bleeding. Imaging of the abdomen revealed a 7 x 4 cm mass in the fundus of the stomach with no evidence of locoregional extension or distant metastasis. Biopsy was not attempted. He was taken to the operating room and intraoperatively the mass was locally invading the left hemidiaphragm. He underwent partial left diaphragmatic resection, total gastrectomy with Roux-en-Y esophago-jejunostomy and feeding tube jejunostomy insertion. Histological studies revealed infiltrating moderately differentiated gastric squamous cell carcinoma with free margins resection, one perigastric lymph node was positive for metastatic disease, for a T4, N1, and M0 disease. Immunohistochemical studies result was positive for cytokeratin 5/6, P63 and negative for CD117, CK20, and P16. He is currently undergoing chemoradiation therapy.

Conclusion: Primary gastric squamous cell carcinoma is more common in men with peak incidence in 6th decade. Most of the data available regarding PGSCC are case reports and no clear pathogenesis of this tumor has been reported. PGSCC is considered an aggressive tumor due to higher incidence of lymphovascular and serosal invasion which are responsible for poor prognosis. Aggressive approach with radical surgical resection is recommended in the absence of distant metastasis. Surgery followed by combined adjuvant chemoradiation is recommended despite the absence of adequate data to support this strategy.