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LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 1  |  Page : 145
 

Primary pure squamous cell carcinoma of the stomach treated with neoadjuvant chemotherapy and surgical resection


1 Department of Hematology and Oncology, St. Joseph's Regional Medical Center, Paterson, NJ, USA
2 Department of Hematology and Oncology, St. Michael's Medical Center, Newark, NJ, USA
3 Department of Pathology, St. Michael's Medical Center, Newark, NJ, USA

Date of Web Publication3-Feb-2016

Correspondence Address:
H Shaaban
Department of Hematology and Oncology, St. Michael's Medical Center, Newark, NJ
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175570

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How to cite this article:
Modi Y, Shaaban H, Parikh N, Guron G, Maroules M. Primary pure squamous cell carcinoma of the stomach treated with neoadjuvant chemotherapy and surgical resection. Indian J Cancer 2015;52:145

How to cite this URL:
Modi Y, Shaaban H, Parikh N, Guron G, Maroules M. Primary pure squamous cell carcinoma of the stomach treated with neoadjuvant chemotherapy and surgical resection. Indian J Cancer [serial online] 2015 [cited 2020 Feb 25];52:145. Available from: http://www.indianjcancer.com/text.asp?2015/52/1/145/175570


Sir,

Primary pure squamous cell carcinomas (SCCs) are extremely rare tumors of the stomach with an incidence of 0.04%-0.07%.[1] The pathogenesis of gastric SCC remains unclear. Several theories have been postulated for the pathogenesis. Strauss et al. summarized the several theories for the pathogenesis of this rare disease entity and postulated that gastric SCC may originate from (1) squamous differentiation in a preexisting adenocarcinoma; (2) squamous metaplasia of gastric mucosa; (3) nests of ectopic squamous epithelium; and (4) a totipotential cell capable of giving rise to any cell type.[2]

A 55-year-old man was admitted to our outpatient clinic with complaints of hematemesis and 5 kg weight loss in 4 months. He was also having black tarry stools for the past 1 week. He also complained of severe fatigue. He admitted to heavy smoking and alcohol use. On physical examination, tenderness was elicited on deep palpation of the epigastric area. The abdomen was distended. Other systems were normal. Melena was observed on rectal examination. The laboratory tests revealed hemoglobin level as 11.2 g/dL, and white blood cell count was 11.500/mm 3 with 80% neutrophils. Occult blood test for stool was positive. Electrolytes and liver and renal function tests were normal. Upper gastrointestinal endoscopy revealed a bleeding, grayish-white, cauliflower-shaped friable mass on the lesser curvature of the stomach, beginning 20 cm distal from the gastroesophageal junction and was approximately 8 cm in diameter. Other parts of the stomach and the duodenum were normal. Multiple endoscopic biopsies were taken. Histopathology of the endoscopic biopsy revealed a well-differentiated SCC with an abundance of keratinizing cell masses, mosaic patterns of cell arrangement, and intercellular bridges in hematoxylin and eosin staining sections [Figure 1] consistent with the diagnosis of SCC. Helicobacter pylori tests were negative. Computed tomography of the chest and abdomen revealed a thickened stomach wall with no distant metastases. The tumor marker carcinoembryonic antigen level was 1 ng/mL (normal 0-2.5). The patient received neoadjuvant chemotherapy with carboplatin and paclitaxel after which, he had successful surgical resection of the tumor. He currently follows up at our clinic and has showed clinical improvement.
Figure 1: Endoscopic biopsy of gastric body shows well-differentiated squamous carcinoma with keratinization (×200 magnification)

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This rare tumor has been reported as very aggressive with a higher frequency of lymphovascular invasion and serosal involvement thus portending a dismal prognosis.[3] Surgery and combined adjuvant radiotherapy and/or chemotherapy is usually administered in the advanced stages of gastric SCC and it seems to display some prognostic benefit.[4] Currently there does not exist any general consensus guidelines on the management and treatment of gastric SCC because most of the data have come from case reports. This is, to our knowledge, the first case of SCC of the stomach treated with neoadjuvant chemotherapy and surgical resection.

 
  References Top

1.
Schmidt C, Schmid A, Lüttges JE, Kremer B, Henne-Bruns D. Primary squamous cell carcinoma of the stomach. Report of a case and review of literature. Hepatogastroenterology 2001;48:1033-6.  Back to cited text no. 1
    
2.
Straus R, Heschel S, Fortmann DJ. Primary adenosquamous carcinoma of the stomach. A case report and review. Cancer 1969;24:985-95.  Back to cited text no. 2
[PUBMED]    
3.
Akbulut S, Finci R, Ozyilkan E. Primary squamous cell carcinoma of the stomach: A case report. Acta Gastroenterol Belg 2003;66:189-90.  Back to cited text no. 3
[PUBMED]    
4.
Dursun M, Yaldiz M, Işikdoğan A, Yilmaz G, Canoruç F, Ormeci N, 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.  Back to cited text no. 4
    


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