Primary gastric squamous cell carcinoma with early chest metastases

What happened, in summary

A 66-year-old man was evaluated for 2 months of epigastric pain and abdominal cramps together with an unintentional 10 kg weight loss. Endoscopy showed an ulcerated lesion in the gastric fundus, and biopsy confirmed primary gastric squamous cell carcinoma. HER2 testing was negative, and preoperative chest and abdominal imaging did not identify another squamous primary or distant disease.

He underwent total gastrectomy with Roux-en-Y reconstruction, splenectomy and D2 lymph-node dissection. Pathology confirmed poorly differentiated gastric squamous cell carcinoma invading the subserosa, with cancer in 9 of 48 regional lymph nodes.

Because this tumor type is extremely rare, further imaging was performed to exclude an occult primary elsewhere. Within weeks after surgery, CT showed enlarged mediastinal and paratracheal lymph nodes and small bilateral lung lesions that had not been visible before surgery. PET/CT confirmed multiple metastatic chest lesions, establishing Stage IV disease.

He received paclitaxel plus carboplatin chemotherapy. At 12 months after chemotherapy began, there had been no further progression and the metastatic chest lesions had regressed slightly, supporting a latest status of stable disease.