Primary Gastric Squamous Cell Carcinoma: A Case Report

Abstract

Purpose: A 75-year-old male with past medical history of hypertension presented to the emergency room with 3-day history of vomiting, 3-month history of progressive weakness, 6-month history of indigestion and history of 10 pound weight loss over the same duration. He was also found to be anemic and had guaiac positive stools. The patient had undergone an outpatient colonoscopy one year prior to admission which was normal. An upper endoscopy was performed for evaluation of symptoms and iron deficiency anemia. Upper endoscopy showed a large ulcerated mass along the lesser curvature of the stomach. Biopsy was confirmatory for poorly differentiated squamous cell carcinoma. Post upper endoscopy, patient underwent a PET scan which was found to be negative. A staging laparoscopy was performed and showed liver metastasis but no peritoneal metastasis. Chemotherapy was initiated with FOLFOX. PET scan done after completion of chemotherapy showed extension of mass to the distal esophagus. Conclusion: Pathogenesis of gastric squamous cell carcinoma is often unknown. Most cases present at an advanced stage and have poor response to chemotherapy. Squamous cell carcinoma should be considered in the endoscopic differential diagnosis when an ulcerating gastric mass is encountered. A better understanding of the pathogenesis and a higher index of suspicion is required to detect gastric squamous cell carcinoma at an earlier stage and hence improve prognosis.