Primary adenosquamous carcinoma of stomach, a rare pathologic figure of gastric carcinoma

سال انتشار: 1392
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 336

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ACPLMED15_052

تاریخ نمایه سازی: 20 آبان 1397

چکیده مقاله:

Adenosquamous carcinoma (ASC) of the stomach is a rare tumor in which varyingproportion of adenocarcinoma and squamous carcinoma coexist most reported cases haveoccurred in the antrum, have been diagnosed at a late stage and have a poor prognosis.We report a 47 years old man with ASC in the antrum. The present case is notable becauseASC is rarely and this case is the first ASC in stomach in more than 13 years ago inTaleghani hospital that is a referral center for GI cancer.Introduction:Primary gastric adenosquamous carcinoma is a rare malignant neoplasia. According to theliterature, the incidence of these tumors collectively varies between 0.04 and 0.7%. Morefrequent in male with a male: female ratio of approximately 4:1 most cases reported in theliterature refer to Asian people especially in Japanese and similar reports are sparse in otherparts of the world. Most reported cases have occurred in the antrum.Adenosquamous cell carcinoma and squamous cell carcinoma comprise less than 1% of allgastric carcinomas, in which varying proportion of adenocarcinoma and squamous carcinomacoexist. squamous component to be present in over 25 percent of the tumor mass.The degree of squamous differentiation and keratinization is variable, but sometimesintercellular bridges and keratin pearl formation maybe obvious.Pure gastric squamous carcinoma is extremely rare, and careful histological sampling ofputative examples often discloses the presence of small foci of adenocarcinoma.ASC havebeen diagnosed at a late stage and have a poor prognosis. The behavior of gastricadenosquamous carcinoma is largely determined by the degree of differentiation of theglandular component, which varies widely.Also ASC show higher frequencies of lymphatic and vascular permeations of the carcinomacells with metastasis in the other abdominal organs like liver, gallbladder, lymph nodes,peritoneum etc.Case report:We report a 47 years old male with a diagnosis of antral adenocarcinoma in previousendoscopy. The specimen was received to department of pathology consists of stomach withattached omentum. On opening an ulcerative mass measuring 10*9cm in distal portion ofstomach (antrum) with1cm distant from distal margin was seen. Wall thickness of tumoralarea was 0.5 to 2 cm in diameter .Tumor borders was elevated. 17 perigastric lymph nodesmeasuring 0.7 to 2 cm in diameter were included. Pathologic sectioning show gastric tumorcomposed of squamous cell carcinoma (75%) and adenocarcinoma (25%). The squamouscomponent was well differentiated with intercellular bridges. The glandular component wasconsists of malignant cells forming glandular structures and some areas of extra cellularmucin. Some foci of tumoral necrosis could be seen. A gradual transition betweenadenocarcinoma and squamous cell carcinoma were present. Tumor invaded through themuscularis propria and serosa. (pT3) Lymph nodes and omentum were free.Discussion:For the diagnosis of a true ASC, it is necessary to confirm the presence of a mixed-patterncarcinoma (glandular and squamous component) outside the cardia, without esophagealinvolvement and without ASC in other organs. Besides this, it is also necessary for thesquamous component to be present in over 25 percent of the tumor mass.According to the literature the majority of gastric adenosquamous carcinomas are stage III orIV advanced cancers. Their prognosis is generally poor. Continuous follow up is required forpatients with these adenosquamous cancers, even after curative resection has been performed,because of the advanced nature of these lesions.Watanabe et al reported low sensitivity to chemotherapy in ASC of the stomach. Aoki et alshow worse outcome for ASC. Terada reported two cases of ASC of the stomach. It isinteresting that two cases showed metastases of adenocarcinoma but not squamous cellcarcinoma. Thus, it seems that the biologic behaviors may be determined by adenocarcinomaelement.Kim et al evaluated about 2500 case of gastric carcinoma, their study consists of 8 cases (1SCC and 7 ASC).They show these tumors are very rare and tend to be at advanced stages oninitial diagnosis, and progress rapidly. They show p53 protein over expression and high Ki-67 labeling index, which might be related to poor prognosis. Endo et al reported a case ofASC of the stomach that produced granulocyte-colony stimulating factor (G-CSF).Some authors reported exceptional cases of ASC; Buchanan reported in 1978 a case withASC in a gastroenteorstomy stoma. Kuroda et al in 2010 reported the first case of gastriclymphoepithelioma-like carcinoma associated with ASC. Also, Yoshida et al reported a caseof early gastric cancer of ASC in stomach that had already metastasized to a regional lymphnode and liver. Clinicians and pathologists should be alerted about the presence of such thesetumors.The origin of adenosquamous carcinoma is unclear. The findings support an origin frommulti-potential cells suffering double differentiation or metaplastic transformation ofadenocarcinoma cells. More studies using modern techniques are required for detection oftumoral cell origin.

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نویسندگان

Zhaleh Mohsenifar

Department of pathology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran

Mohammad Reza Bediei

Department of surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran