Adenosquamous gastric carcinoma in Caucasian patient

S. Blázquez, A. Raventós, M. L. Díaz, J. F. García-Fontgivell, S. Martínez and J. J. Sirvent

Department of Pathology. Hospital Universitario Joan XXIII. Tarragona. Spain

 

In a 56-year-old Caucasian woman an ulcerated malignant mass was found at the gastric antrum in a endoscopical study due to chronic anemia. The microscopical study exhibited a malignant tumor composed of two different epithelial cell types (Fig. 1), with an infiltrating growth pattern, and wide necrotic and hemorrhage areas. Nearly 60% of the tumor was an atypical polygonal cell proliferation with intercellular bridges, keratin, and presence of pearl corns (Fig. 2), which was a squamous carcinoma. The rest of the tumor (40%) was an atypical glandular proliferation with back-to-back phenomenon corresponding to an adenocarcinoma. The mitotic rate was high in both components. The tumor was perforated, so the 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 Asian patients. Only a few cases have been published in our country, and most of them in Asian patients too (2,3); thus, the interest of this case is that it happened in a Caucasian patient. The origin of these tumors is controversial; the squamous component may develop from previous foci of squamous metaplasia or from the dedifferentiation of primitive cells. Electronic microscopical studies done in these types of tumors demonstrate that some individual cells contain both specific ultrastructural components such as tonofibrils and mucous vacuoles (2,4).

The differential diagnosis includes poor differentiated adenocarcinoma, collision tumors, pure squamous gastric carcinoma, mucoepidermoid carcinoma, and metastatic tumors. Finally, adenosquamous gastric carcinoma has a worse prognosis and more aggressive behavior versus conventional gastric adenocarcinoma, due to its tendency towards vascular and/or lymph-node invasion (5).

REFERENCES

1. Mingazzini PL, Barsotti P, Malchiodi Albedi F. Adenosquamous carcinoma of the stomach: histological, histochemical and ultrastructural observations. Histopathology 1983; 7: 433-43.

2. Mori M, Fukuda T, Enjoji M. Adenosquamous carcinoma of the stomach. Histogenetic and ultrastructural studies. Gastroenterology 1987; 92: 1078-82.

3. Piper MH, Ross JM, Bever FN, Shartsis JM, Mohammadi D. Primary squamous cell carcinoma of a gastric remnant. Am J Gastroenterol 1991; 86: 1080-2.

4. Yokozaki H. Molecular characteristics of eight gastric cancer cell lines established in Japan. Pathol Int 2000; 50: 767-77.

5. Toyota N, Minagi S, Takeuchi T, Sadamitsu N. Adenosquamous carcinoma of the stomach associated with separate early gastric cancer (type IIc). J Gastroenterol 1996; 31: 105-8.