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A case of two primary gastric malignancies: adenocarcinoma and squamous cell carcinoma of the stomach
A case of two primary gastric malignancies: adenocarcinoma and squamous cell carcinoma of the stomach Steven Guttmann, MD, Nelli Fromer, DO, Steven Shamah, MD, Jack Braha, DO, Jane Vlodov, MD, Nison Badalov, MD Brooklyn, New York, USA
Gastric cancer is the second leading cause of death from cancer worldwide. Despite this fact, there has been an overall decrease in the incidence of gastric cancer over the past few decades.1 Therefore, it is important to understand the different histological manifestations of the disease. The most common form of gastric cancer is adenocarcinoma. In contrast, squamous cell carcinoma of the stomach is rare and has been described in numerous case reports.2,3 In addition, cases of primary gastric adenosquamous carcinoma also have been reported.4,5 We present a case of a woman with two gastric tumors in separate locations with different histological characteristics; one an adenocarcinoma, the other squamous cell carcinoma. To our knowledge there are no reported cases of two separate gastric primary tumors consisting of these two pathologic diagnoses.
CASE REPORT
Figure 2. Invasive squamous cell carcinoma (H&E, orig. mag. X100).
An 81-year-old woman with a history of hypertension presented to her physician experiencing epigastric pain radiating to the back, associated with weight loss. She denied any other symptoms. Family history was significant for a brother who died from gastric cancer of unknown type. She denied tobacco or alcohol use. On examination, the patient had tenderness in the epigastric region. Laboratory studies revealed a hemoglobin of 9.8 g/dL (normal 14.0-18.0 g/dL). Endoscopy revealed a 4-cm, deeply ulcerated, raised lesion, 4 cm above the pylorus, with an irregular border at the lesser
Figure 3. Adenocarcinoma with ulceration (H&E, orig. mag. X100).
curvature (Fig. 1). Another 2-cm, flat, mildly ulcerated lesion in the body of the stomach was noted. The biopsy results of the first lesion revealed invasive squamous cell carcinoma with ulceration (Fig. 2), the second lesion was adenocarcinoma with ulceration (Fig. 3).
DISCUSSION
Figure 1. Invasive squamous cell carcinoma (gross).
www.giejournal.org
Adenocarcinoma is the most common type of gastric cancer, accounting for more than 90% of gastric tumors; it Volume 75, No. 5 : 2012 GASTROINTESTINAL ENDOSCOPY 1113
Brief Reports
arises from the glandular epithelium of the gastric mucosa. In contrast, squamous cell carcinoma of the stomach is uncommon, with an incidence of less than 1% worldwide.6 Because it is rare, the mechanism of this disease has not been well-understood, and many theories have been proposed, including association between Helicobacter pylori infection and chronic mucosal damage leading to squamous metaplasia. Our patient was found to have two separate, histologically different primary tumors in the stomach in two distinct locations. H pylori testing was negative in both biopsy samples. The patient did not have risk factors for development of gastric cancer. However, her brother did have gastric adenocarcinoma. No other family members were known to have any malignancies. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. REFERENCES 1. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce
2.
3.
4.
5. 6.
cancer disparities in different geographic regions of the world. J Clin Oncol 2006;24:2137–21. Dursun M, Yaldz M, Iskdogan A, et al. Primary squamous cell carcinoma of the stomach: a case report and review of the literature. Eur J Gastroenterol Hepatol 2003;15:329-30. Karaca G, Pekcici MR, Ozer H, et al. Primary squamous cell carcinoma of the stomach in a 68 years old man. Geriatr Gerontol Int 2010;11: 119-20. Faria GR, Eloy C, Preto JR, et al. Primary gastric adenosquamous carcinoma in a Caucasian woman: a case report. J Med Case Reports 2010; 4:351. Mori M, Iwashita A, Enjoji M. Squamous cell carcinoma of the stomach: report of three cases. Am J Gastroenterol 1986;81:339-42. Amuluru K, Gupta H. Primary squamous cell carcinoma of the stomach: a case report. J Gastrointest Cancer 2010;41:24-6.
Current affiliation: Department of Gastroenterology, Maimonides Medical Center, Brooklyn, New York, USA Reprint requests: Steven Guttmann, MD, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219. Copyright © 2012 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 doi:10.1016/j.gie.2011.05.037
GIE on Facebook GIE now has a Facebook page. Fans will receive news, updates, and links to author interviews, podcasts, articles, and tables of contents. Search on Facebook for “GIE: Gastrointestinal Endoscopy” and become a fan.
1114 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 5 : 2012
www.giejournal.org
Gastric cancer is the second leading cause of death from cancer worldwide. Despite this fact, there has been an overall decrease in the incidence of gastric cancer over the past few decades.1 Therefore, it is important to understand the different histological manifestations of the disease. The most common form of gastric cancer is adenocarcinoma. In contrast, squamous cell carcinoma of the stomach is rare and has been described in numerous case reports.2,3 In addition, cases of primary gastric adenosquamous carcinoma also have been reported.4,5 We present a case of a woman with two gastric tumors in separate locations with different histological characteristics; one an adenocarcinoma, the other squamous cell carcinoma. To our knowledge there are no reported cases of two separate gastric primary tumors consisting of these two pathologic diagnoses.
CASE REPORT
Figure 2. Invasive squamous cell carcinoma (H&E, orig. mag. X100).
An 81-year-old woman with a history of hypertension presented to her physician experiencing epigastric pain radiating to the back, associated with weight loss. She denied any other symptoms. Family history was significant for a brother who died from gastric cancer of unknown type. She denied tobacco or alcohol use. On examination, the patient had tenderness in the epigastric region. Laboratory studies revealed a hemoglobin of 9.8 g/dL (normal 14.0-18.0 g/dL). Endoscopy revealed a 4-cm, deeply ulcerated, raised lesion, 4 cm above the pylorus, with an irregular border at the lesser
Figure 3. Adenocarcinoma with ulceration (H&E, orig. mag. X100).
curvature (Fig. 1). Another 2-cm, flat, mildly ulcerated lesion in the body of the stomach was noted. The biopsy results of the first lesion revealed invasive squamous cell carcinoma with ulceration (Fig. 2), the second lesion was adenocarcinoma with ulceration (Fig. 3).
DISCUSSION
Figure 1. Invasive squamous cell carcinoma (gross).
www.giejournal.org
Adenocarcinoma is the most common type of gastric cancer, accounting for more than 90% of gastric tumors; it Volume 75, No. 5 : 2012 GASTROINTESTINAL ENDOSCOPY 1113
Brief Reports
arises from the glandular epithelium of the gastric mucosa. In contrast, squamous cell carcinoma of the stomach is uncommon, with an incidence of less than 1% worldwide.6 Because it is rare, the mechanism of this disease has not been well-understood, and many theories have been proposed, including association between Helicobacter pylori infection and chronic mucosal damage leading to squamous metaplasia. Our patient was found to have two separate, histologically different primary tumors in the stomach in two distinct locations. H pylori testing was negative in both biopsy samples. The patient did not have risk factors for development of gastric cancer. However, her brother did have gastric adenocarcinoma. No other family members were known to have any malignancies. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. REFERENCES 1. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce
2.
3.
4.
5. 6.
cancer disparities in different geographic regions of the world. J Clin Oncol 2006;24:2137–21. Dursun M, Yaldz M, Iskdogan A, et al. Primary squamous cell carcinoma of the stomach: a case report and review of the literature. Eur J Gastroenterol Hepatol 2003;15:329-30. Karaca G, Pekcici MR, Ozer H, et al. Primary squamous cell carcinoma of the stomach in a 68 years old man. Geriatr Gerontol Int 2010;11: 119-20. Faria GR, Eloy C, Preto JR, et al. Primary gastric adenosquamous carcinoma in a Caucasian woman: a case report. J Med Case Reports 2010; 4:351. Mori M, Iwashita A, Enjoji M. Squamous cell carcinoma of the stomach: report of three cases. Am J Gastroenterol 1986;81:339-42. Amuluru K, Gupta H. Primary squamous cell carcinoma of the stomach: a case report. J Gastrointest Cancer 2010;41:24-6.
Current affiliation: Department of Gastroenterology, Maimonides Medical Center, Brooklyn, New York, USA Reprint requests: Steven Guttmann, MD, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219. Copyright © 2012 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 doi:10.1016/j.gie.2011.05.037
GIE on Facebook GIE now has a Facebook page. Fans will receive news, updates, and links to author interviews, podcasts, articles, and tables of contents. Search on Facebook for “GIE: Gastrointestinal Endoscopy” and become a fan.
1114 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 5 : 2012
www.giejournal.org