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CC BY 4.0 · Endoscopy 2024; 56(S 01): E288-E289
DOI: 10.1055/a-2277-0462
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Rare case of early squamous cell carcinoma extending from the cardia to the fundus cured by endoscopic submucosal dissection

Authors

  • Tingzhu Lan  ‡

    1   Gastroenterology, The Seventh Medical Center of PLA General Hospital, Beijing, China (Ringgold ID: RIN617516)
    2   Gastroenterology, Longgang District Central Hospital of Shenzhen, Shenzhen, China

  • Hui Xie‡

    1   Gastroenterology, The Seventh Medical Center of PLA General Hospital, Beijing, China (Ringgold ID: RIN617516)

  • Xianzong Ma 

    1   Gastroenterology, The Seventh Medical Center of PLA General Hospital, Beijing, China (Ringgold ID: RIN617516)
    3   Medical School of Chinese PLA, Beijing, China (Ringgold ID: RIN104607)

  • Lang Yang 

    1   Gastroenterology, The Seventh Medical Center of PLA General Hospital, Beijing, China (Ringgold ID: RIN617516)
    4   Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China

  • Peng Jin 

    1   Gastroenterology, The Seventh Medical Center of PLA General Hospital, Beijing, China (Ringgold ID: RIN617516)
    4   Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China

Supported by: Research program of Chinese PLA 18CXZ027
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A 70-year-old asymptomatic man with a preference for hot food and chronic alcohol consumption presented to our hospital for screening esophagogastroduodenoscopy, which revealed squamous metaplasia extending from the cardia to the fundus of the stomach ([Fig. 1]). Narrow-band imaging and magnified endoscopy showed a brown area and abnormal intraepithelial papillary capillary loops of type B1 within the squamous metaplasia of the stomach mucosa ([Fig. 2]), suggestive of early squamous cell carcinoma (SCC) with a low risk of submucosal infiltration. Biopsy confirmed high-grade dysplasia of the squamous epithelium. Endoscopic submucosal dissection (ESD) was performed to resect the lesion ([Video 1]). Lugol’s iodine staining was used to determine the margin of the neoplasm before ESD, revealing a clear unstained area within a large area of dark brown mucosa ([Fig. 3]). Some columnar epithelial islands remained within the squamous metaplasia of the mucosa, with some unstained areas located outside the lesion. The lesion was completely resected without complications ([Fig. 4]). Histopathology confirmed an intramucosal SCC infiltrating into the lamina propria (pT1a-M2) ([Fig. 5]).

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Fig. 1 Squamous metaplasia extending from the cardia to the fundus of the stomach (white area).
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Fig. 2 Narrow-band imaging revealed a brown area and abnormal intraepithelial papillary capillary loops within the squamous metaplasia of the gastric mucosa.
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Fig. 3 Lugol’s iodine staining showed a clear unstained lesion within the dark brown mucosa.
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Fig. 4 Appearance after complete lesion resection by endoscopic submucosal dissection.
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Fig. 5 Histopathology confirmed an intramucosal squamous cell carcinoma infiltrating into the lamina propria.
Endoscopic submucosal dissection (ESD) for early squamous cell carcinoma (SCC) extending from the cardia to the fundus.Video 1

Early SCC extending from the cardia to the fundus is an exceedingly rare type of gastric cancer. Smoking and the presence of gastric squamous metaplasia are often related to SCC. The cause of SCC may be related to long-term chronic inflammation of the gastric squamous-columnar junction, where normal columnar epithelium is replaced by squamous epithelium and then undergoes malignant change. This case confirms the relationship between SCC and squamous metaplasia of the gastric mucosa.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Correspondence

Peng Jin, MD, PhD
Department of Gastroenterology, Seventh Medical Center of Chinese PLA General Hospital
Nanmenchang 5#, Dongcheng District
Beijing, CN100700
China   

Publication History

Article published online:
20 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Zoom
Fig. 1 Squamous metaplasia extending from the cardia to the fundus of the stomach (white area).
Zoom
Fig. 2 Narrow-band imaging revealed a brown area and abnormal intraepithelial papillary capillary loops within the squamous metaplasia of the gastric mucosa.
Zoom
Fig. 3 Lugol’s iodine staining showed a clear unstained lesion within the dark brown mucosa.
Zoom
Fig. 4 Appearance after complete lesion resection by endoscopic submucosal dissection.
Zoom
Fig. 5 Histopathology confirmed an intramucosal squamous cell carcinoma infiltrating into the lamina propria.