Case Report
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World J Gastroenterol. Aug 7, 2014; 20(29): 10193-10201
Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.10193
Fever as a first manifestation of advanced gastric adenosquamous carcinoma: A case report
Harsha Ajoodhea, Ren-Chao Zhang, Xiao-Wu Xu, Wei-Wei Jin, Ke Chen, Yong-Tao He, Yi-Ping Mou
Harsha Ajoodhea, Ren-Chao Zhang, Xiao-Wu Xu, Wei-Wei Jin, Ke Chen, Yi-Ping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Yong-Tao He, Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Author contributions: Zhang RC, Xu XW and Mou YP performed the operation; Jin WW and Chen K collected case data; He YT proofread all the pathological data; Ajoodhea H and Zhang RC wrote the manuscript; Mou YP proofread and revised the manuscript; all authors approved the version to be published.
Supported by Natural Science Foundation of Zhejiang Province, China, grant No. LQ13H160007
Correspondence to: Yi-Ping Mou, MD, FACS, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. mouyp@srrsh.com
Telephone: +86-571-86006952 Fax: +86-571-86044817
Received: December 28, 2013
Revised: March 24, 2014
Accepted: April 21, 2014
Published online: August 7, 2014
Abstract

Gastric adenosquamous carcinoma (ASC) is a rare type of gastric cancer. It is a mixed neoplasm, consisting of glandular cells and squamous cells. It is often diagnosed at an advanced stage, thus carrying a poor prognosis. We describe a case of a 73-year-old male, who presented with refractory fever and an intra-abdominal mass on imaging. He underwent a laparoscopic exploration followed by a successful totally laparoscopic total gastrectomy with D2 lymphadenectomy for gastric cancer. Postoperative pathology revealed primary gastric ASC (T4aN0M0). The patient received adjuvant radiotherapy and chemotherapy with S1 and is alive 20 mo after surgery without recurrence. This is the first case of advanced gastric ASC with fever as the initial presentation treated with totally laparoscopic total gastrectomy reported in the English literature.

Keywords: Gastric adenosquamous carcinoma, Advanced gastric cancer, Malignant tumor, Laparoscopic gastrectomy, Totally laparoscopic total gastrectomy

Core tip: Totally laparoscopic total gastrectomy for advanced primary adenosquamous carcinoma of the stomach with fever as the initial manifestation is an interesting combination of a rare lesion with an atypical presentation and an uncommon complex surgical procedure. Given the aggressive nature and advanced stage at diagnosis, there are no reports of this carcinoma in the English literature. To the best of our knowledge, this is the first case of its kind reported in the English literature.