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A Rare Case of a Primary Squamous Cell Carcinoma of the Stomach Presenting as a Submucosal Mass.

von Waagner W, Wang Z, Picon AI - Case Rep Surg (2015)

Bottom Line: Imaging of the chest, abdomen, and pelvis showed no evidence of local or distant metastasis.Pathology showed a gastric squamous cell carcinoma (SCC) invading the diaphragm, with negative margins of resection, and one positive perigastric lymph node.He received chemoradiation, but the patient expired 27 months after surgery.

View Article: PubMed Central - PubMed

Affiliation: Division of Surgical Oncology, Department of Surgery, Staten Island University Hospital, 256 B Mason Avenue, Staten Island, NY 10305, USA.

ABSTRACT
We report a case of a 70-year-old man, with a status after aortic valve replacement, who presented with melena and hypotension. On physical examination, he was hypotensive, but he responded to resuscitation. Esophagogastroduodenoscopy revealed a submucosal mass in the gastric fundus. Imaging of the chest, abdomen, and pelvis showed no evidence of local or distant metastasis. He underwent a partial diaphragmatic resection, gastrectomy, lymphadenectomy, and Roux-en-Y esophagojejunostomy. Pathology showed a gastric squamous cell carcinoma (SCC) invading the diaphragm, with negative margins of resection, and one positive perigastric lymph node. He received chemoradiation, but the patient expired 27 months after surgery.

No MeSH data available.


Related in: MedlinePlus

Computerized axial tomography scan with IV and PO contrast showing a mass in the gastric fundus (red arrow).
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fig2: Computerized axial tomography scan with IV and PO contrast showing a mass in the gastric fundus (red arrow).

Mentions: We report a case of a 70-year-old white male, with a status after uncomplicated aortic valve replacement for severe aortic stenosis, who presented with melena and hypotension, returning to the hospital the same day of discharge. He reported a 15-pound weight loss over a few months. His past medical history was significant for a 60-pack-year smoking history and severe aortic stenosis. On physical examination, he was pale, tachycardic, and hypotensive, but he responded well to resuscitation. Esophagogastroduodenoscopy (EGD) revealed a seven-centimeter ulcerated submucosal mass in the fundus of the stomach without active bleeding (Figure 1), and biopsy was not attempted. Imaging of the chest and abdomen revealed a 7 × 4 cm mass in the gastric fundus with no evidence of locoregional extension or distant metastasis (Figure 2). He was taken to the operating room and it was found that the mass was locally invading the left hemidiaphragm. He underwent a partial left diaphragmatic resection, total gastrectomy, D1A lymphadenectomy, reconstruction with Roux-en-Y esophagojejunostomy, and a feeding tube jejunostomy. Histological and immunohistochemical analysis revealed an infiltrating moderately differentiated gastric squamous cell carcinoma (SCC) with direct invasion to the adjacent diaphragm striated muscle, with free margin resection, and one perigastric lymph node was positive for metastatic disease for a T4, N1, and M0 disease. Immunohistochemistry was positive for cytokeratin 5/6, p63 and negative for CD117, CK20, and p16. Three months after surgery, he was started on adjuvant radiation therapy and chemotherapy with capecitabine and oxaliplatin. He developed recurrent disease in the peritoneum and multiple liver metastases were found on positron emission tomography scan (PET). He received sorafenib, but he presented severe fatigue and the dose was decreased and eventually stopped. Carboplatin plus irinotecan was started 16 months after surgery due to progression of liver metastases. Twenty months after surgery, imaging showed progression of disease and 5-fluorouracil and gemcitabine were started with no response. Subsequently, he had progression of disease and expired 27 months after surgery.


A Rare Case of a Primary Squamous Cell Carcinoma of the Stomach Presenting as a Submucosal Mass.

von Waagner W, Wang Z, Picon AI - Case Rep Surg (2015)

Computerized axial tomography scan with IV and PO contrast showing a mass in the gastric fundus (red arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4491394&req=5

fig2: Computerized axial tomography scan with IV and PO contrast showing a mass in the gastric fundus (red arrow).
Mentions: We report a case of a 70-year-old white male, with a status after uncomplicated aortic valve replacement for severe aortic stenosis, who presented with melena and hypotension, returning to the hospital the same day of discharge. He reported a 15-pound weight loss over a few months. His past medical history was significant for a 60-pack-year smoking history and severe aortic stenosis. On physical examination, he was pale, tachycardic, and hypotensive, but he responded well to resuscitation. Esophagogastroduodenoscopy (EGD) revealed a seven-centimeter ulcerated submucosal mass in the fundus of the stomach without active bleeding (Figure 1), and biopsy was not attempted. Imaging of the chest and abdomen revealed a 7 × 4 cm mass in the gastric fundus with no evidence of locoregional extension or distant metastasis (Figure 2). He was taken to the operating room and it was found that the mass was locally invading the left hemidiaphragm. He underwent a partial left diaphragmatic resection, total gastrectomy, D1A lymphadenectomy, reconstruction with Roux-en-Y esophagojejunostomy, and a feeding tube jejunostomy. Histological and immunohistochemical analysis revealed an infiltrating moderately differentiated gastric squamous cell carcinoma (SCC) with direct invasion to the adjacent diaphragm striated muscle, with free margin resection, and one perigastric lymph node was positive for metastatic disease for a T4, N1, and M0 disease. Immunohistochemistry was positive for cytokeratin 5/6, p63 and negative for CD117, CK20, and p16. Three months after surgery, he was started on adjuvant radiation therapy and chemotherapy with capecitabine and oxaliplatin. He developed recurrent disease in the peritoneum and multiple liver metastases were found on positron emission tomography scan (PET). He received sorafenib, but he presented severe fatigue and the dose was decreased and eventually stopped. Carboplatin plus irinotecan was started 16 months after surgery due to progression of liver metastases. Twenty months after surgery, imaging showed progression of disease and 5-fluorouracil and gemcitabine were started with no response. Subsequently, he had progression of disease and expired 27 months after surgery.

Bottom Line: Imaging of the chest, abdomen, and pelvis showed no evidence of local or distant metastasis.Pathology showed a gastric squamous cell carcinoma (SCC) invading the diaphragm, with negative margins of resection, and one positive perigastric lymph node.He received chemoradiation, but the patient expired 27 months after surgery.

View Article: PubMed Central - PubMed

Affiliation: Division of Surgical Oncology, Department of Surgery, Staten Island University Hospital, 256 B Mason Avenue, Staten Island, NY 10305, USA.

ABSTRACT
We report a case of a 70-year-old man, with a status after aortic valve replacement, who presented with melena and hypotension. On physical examination, he was hypotensive, but he responded to resuscitation. Esophagogastroduodenoscopy revealed a submucosal mass in the gastric fundus. Imaging of the chest, abdomen, and pelvis showed no evidence of local or distant metastasis. He underwent a partial diaphragmatic resection, gastrectomy, lymphadenectomy, and Roux-en-Y esophagojejunostomy. Pathology showed a gastric squamous cell carcinoma (SCC) invading the diaphragm, with negative margins of resection, and one positive perigastric lymph node. He received chemoradiation, but the patient expired 27 months after surgery.

No MeSH data available.


Related in: MedlinePlus