Exuberant squamous metaplasia of the gastric mucosa in a patient with gastric adenocarcinoma

Abstract

BackgroundThe presence of squamous epithelium in the stomach is only occasionally encountered and is associated with prolonged mucosal injury. Squamous metaplasia in patients with cancer is relatively rare and only four cases have been reported in the stomach, all of which have been associated with squamous cell carcinomas. We present the first case of exuberant squamous metaplasia in a patient with gastric adenocarcinoma of the cardia.Case presentationA 56-year-old woman presented with epigastric pain and weight loss. Endoscopy showed an irregular depressed hyperemic lesion covered with a whitish plaque on the cardia. A total gastrectomy was performed and the tumor in the subcardia was found to extend up to the proximal stomach with diffuse squamous metaplasia in the surface of the tumor and proximal gastric mucosa in contiguity with the esophageal squamous epithelium. It is believed that the squamous extension from the esophagus to the proximal stomach and the gastric adenocarcinoma occurred at the same time.ConclusionsSynchronous squamous metaplasia and underlying adenocarcinoma in the stomach is extremely rare. Recognition of this entity would be beneficial for clinicians to avoid unnecessary treatment.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1035146445160150.

Three types of metaplasia model through Kras activation, Pten deletion, or Cdh1 deletion in the gastric epithelium

“…The finding that glandular epithelium was gradually replaced with squamous epithelium, which seemed to expand from the lesser curvature side of the squamocolumnar junction, supports the ‘competition’ model for establishing the boundary of squamous and glandular epithelium . In fact, there have been several reports of squamous metaplasia in the gastric cardia in the setting of chronic injury to glandular epithelium , which might be modeled by our Tff1 ‐Cre; Cdh1 flox/flox mice.…”

Long‐term follow up of gastric squamous metaplasia

“…Squamous metaplasia without atypia is rarely seen in the stomach. Moreover, it rarely develops at the antrum, with most located at the lesser curvature of the cardia or gastric body . The pathogenesis of squamous metaplasia is uncertain.…”

“…Squamous cell carcinoma occasionally develops from gastric squamous metaplasia . and, therefore, this should be carefully observed and followed up.…”

“…3 Squamous cell carcinoma occasionally develops from gastric squamous metaplasia. 1,4,5 and, therefore, this should be carefully observed and followed up. To the best of our knowledge, this is the first report of long-term follow up for squamous metaplasia.…”

“…Moreover, it rarely develops at the antrum, with most located at the lesser curvature of the cardia or gastric body. 1 The pathogenesis of squamous metaplasia is uncertain. According to one report, squamous epithelial cells in the gastric mucosa are associated with chronic inflammation, such as chronic gastritis and ulcerative lesion, and develop as a differentiation of multipotent stem cells.…”