Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2015; 21(14): 4385-4390
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4385
Fatal submucosal invasive gastric adenosquamous carcinoma detected at surveillance after gastric endoscopic submucosal dissection
Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Shigeki Sekine, Ryoji Kushima, Yutaka Saito, Takeo Fukagawa, Hitoshi Katai
Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Shigeki Sekine, Pathology Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Ryoji Kushima, Department of Clinical Laboratory Medicine and Diagnostic Pathology, Shiga University of Medical Science, Otsu 520-2192, Japan
Takeo Fukagawa, Hitoshi Katai, Gastric Surgery Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Author contributions: Shirahige A, Suzuki H and Oda I wrote the manuscript; Sekiguchi M, Mori G, Abe S, Nonaka S, Yoshinaga S, Sekine S, Kushima R, Saito Y, Fukagawa T and Katai H contributed to the manuscript discussion and reviewed the manuscript.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: No conflict of interest was declared by the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Haruhisa Suzuki, MD, Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. harusuzu@ncc.go.jp
Telephone: +81-3-35422511 Fax: +81-3-35423815
Received: October 14, 2014
Peer-review started: October 15, 2014
First decision: November 14, 2014
Revised: November 28, 2014
Accepted: January 30, 2015
Article in press: January 30, 2015
Published online: April 14, 2015
Processing time: 182 Days and 11.8 Hours
Abstract

An 80-year-old man was under annual surveillance esophagogastroduodenoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Two years after the initial ESD, a 0-IIc type metachronous EGC lesion, 8 mm in size, without an ulcer scar, was found in the gastric antrum. The estimated tumor depth was up to the mucosa, and biopsy revealed well and poorly differentiated adenocarcinoma. ESD was performed for this lesion and en bloc resection with negative margins was achieved. Histopathological examination revealed an adenosquamous carcinoma 8 mm in size invading the deep submucosal layer (1600 μm), with lymphovascular invasion, consistent with the diagnosis of non-curative resection. Additional gastrectomy was recommended for this patient; however, two months after the ESD, preoperative computed tomography revealed multiple liver metastases, and the patient was considered as an unsuitable candidate for surgical resection. Systemic chemotherapy was therefore started; however, the patient died of gastric cancer 27 mo after the second ESD. Early gastric adenosquamous carcinoma localized to the mucosa and submucosa is extremely rare and its clinical behavior is not well known. The present report is very significant in that it underscores the distinct possibility of gastric adenosquamous carcinoma being very aggressive and fatal even when detected at an early cancer.

Keywords: Early gastric cancer; Endoscopic submucosal dissection; Gastric adenosquamous carcinoma; Gastric cancer-related death; Liver metastasis; Metachronous cancer; Surveillance

Core tip: Herein is described a rare case of gastric adenosquamous carcinoma which resulted in liver metastasis and gastric cancer-related death, even though the tumor was detected at an early cancer by periodic surveillance esophagogastroduodenoscopy after gastric endoscopic submucosal dissection. Early gastric adenosquamous carcinoma is extremely rare and its clinical behavior is not well known. The present study is very significant in that it underscores the distinct possibility of gastric adenosquamous carcinoma being very aggressive and fatal even when detected at an early cancer.