Adenosquamous gastric carcinoma in Caucasian patient

Abstract

In a 56-year-old Caucasian woman an ulcerated malignant mass was found at the gastric antrum in a endoscopicalstudy due to chronic anemia. The microscopical study exhibited a malignant tumor composed of two different epithelialcell types (Fig. 1), with an infiltrating growth pattern, and wide necrotic and hemorrhage areas. Nearly 60% of the tumorwas an atypical polygonal cell proliferation with intercellular bridges, keratin, and presence of pearl corns (Fig. 2), whichwas a squamous carcinoma. The rest of the tumor (40%) was an atypical glandular proliferation with back-to-back pheno-menon corresponding to an adenocarcinoma. The mitotic rate was high in both components. The tumor was perforated, sothe patient had a secondary sepsis and died a few days after surgery.Adenosquamous gastric carcinoma represents about 1% of all gastric tumors (1), with most of them occurring in Asianpatients. Only a few cases have been published in our country, and most of them in Asian patients too (2,3); thus, the inte-rest of this case is that it happened in a Caucasian patient. The origin of these tumors is controversial; the squamous com-ponent may develop from previous foci of squamous metaplasia or from the dedifferentiation of primitive cells. Electronicmicroscopical studies done in these types of tumors demonstrate that some individual cells contain both specific ultras-tructural components such as tonofibrils and mucous vacuoles (2,4).The differential diagnosis includes poor differentiated adenocarcinoma, collision tumors, pure squamous gastric carci-noma, mucoepidermoid carcinoma, and metastatic tumors. Finally, adenosquamous gastric carcinoma has a worse prog-nosis and more aggressive behavior