A Rare Case of Squamous Gastric Carcinoma
A 67-year-old man presented to the hospital with progressive shortness of breath for 4 days, which worsened with exertion and was relieved by rest. He also noted one episode of dark vomitus and one episode of melena a few days prior to admission.
History. The patient had a past medical history of hypertension and atrial fibrillation. He denied any change in weight, nausea, abdominal pain, and night sweats. He was not taking any anticoagulants. His family history was non-contributory. He smoked for greater than 30 pack-years and denied alcohol or illicit drug use.
On physical examination, he had marked conjunctival pallor and an irregularly irregular pulse. The rest of the examination was unremarkable, including no palpable abdominal mass, abdominal distension, or lymphadenopathy.
Diagnostic testing. Laboratory studies revealed a hemoglobin of 4.3 g/dL. His anemia was normochromic, normocytic, and without anisocytosis. An abdomen computed tomography (CT) scan with intravenous and oral contrast revealed a 10 cm mass along the lesser curvature of the stomach involving the pancreatic body and tail with encasement of the splenic artery with no perigastric varices (Figure 1). The patient was then transfused with four units of packed red blood cells.
Figure 1. CT of the abdomen showing a 10 cm mass along the lesser curvature of the stomach (red arrow) involving the pancreatic body and tail with encasement of the splenic artery in transverse (A) and coronal plan (B).
An endoscopic examination showed a large, cratered ulcer in the gastric cardia and body of the stomach, which was biopsied (Figure 2). No active bleeding was observed at the time of the examination.
Figure 2. Endoscopy showing a large, cratered ulcer (white arrow) in the gastric cardia and body of the stomach.
Helicobacter pylori returned negative. Pathology results of the biopsy revealed a grade 3 squamous cell gastric carcinoma (Figure 3). Immunohistochemistry staining of the tumor showed CK7+, p63+, b72.3-, MOC31-, CK20-, and CDX2-, consistent with squamous cell gastric carcinoma. The tumor was negative for HER2/neu and PDL-1.