J Gastric Cancer.  2016 Jun;16(2):120-124. 10.5230/jgc.2016.16.2.120.

Primary Squamous Cell Carcinoma of the Remnant Stomach after Subtotal Gastrectomy

• Chang YS
• Kim MS
• Kim DH
• Park S
• You JY
• Han JK
• Kim SH
• Lee HJ

• KMID: 2328080
• DOI: http://doi.org/10.5230/jgc.2016.16.2.120

Abstract

Primary squamous cell carcinoma (SCC) of the stomach is a very rare disease. However, the pathogenesis, clinical characteristics, and prognosis of gastric SCC are controversial and remain to be elucidated. Herein, we report a case of primary gastric SCC of the remnant stomach after subtotal gastrectomy. A 65-year-old man was admitted to our hospital due to epigastric discomfort and dizziness. He had undergone subtotal gastrectomy 40 years previously for gastric ulcer perforation. Endoscopy revealed a normal esophagus and a large mass in the remnant stomach. Abdominal computed tomography revealed enhanced wall thickening of the anastomotic site and suspected metachronous gastric cancer. Endoscopic biopsy revealed SCC. Total gastrectomy was performed with Roux-en-Y esophagojejunostomy. A 10-cm tumor was located at the remnant stomach just proximal to the previous area of anastomosis. Pathologic examination showed well-differentiated SCC extended into the subserosa without lymph node involvement (T3N0M0). The patient received adjuvant systemic chemotherapy with 6 cycles of 5-FU and cisplatin regimen, and he is still alive at the 54-month follow-up. According to the treatment principles of gastric cancer, early detection and radical surgical resection can improve the prognosis.

Keyword

Stomach neoplasms; Squamous cell carcinoma; Gastric stump

MeSH Terms

Aged
Biopsy
Carcinoma, Squamous Cell*
Cisplatin
Dizziness
Drug Therapy
Endoscopy
Epithelial Cells*
Esophagus
Fluorouracil
Follow-Up Studies
Gastrectomy*
Gastric Stump*
Humans
Lymph Nodes
Prognosis
Rare Diseases
Stomach
Stomach Neoplasms
Stomach Ulcer
Cisplatin
Fluorouracil

Figure

• 

  Fig. 1 Endoscopy shows a hemorrhagic and fungating tumor in the remnant stomach near the site of a previous gastrojejunostomy.

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  Fig. 2 Abdominal computed tomography scan shows heterogeneous wall thickening of the remnant stomach.

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  Fig. 3 A hypermetabolic mass of the stomach (maximum standard uptake value: 21.7) was identified via whole body positron emission tomography. Another primary cancer or distant metastases were excluded.

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  Fig. 4 The resected specimen of the gastric squamous cell carcinoma, which was located in the remnant stomach, is shown. The tumor was 10 cm in size and clear resection margins were secured from the esophagogastric junction and jejunum.

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  Fig. 5 Pathologic findings of well-differentiated squamous cell carcinoma with the mosaic arrangement and keratin pearls (H&E, ×100).

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