A case report of adenosquamous carcinoma of the esophagogastric junction

Abstract

Background Many types of tumors can arise in the esophagogastric junction (EGJ). Squamous cell carcinoma (SCC) arising from the esophageal epithelia, adenocarcinoma arising from the gastric mucosa, or Barrett’s esophageal mucosa are frequently observed in the EGJ. However, adenosquamous carcinoma (ASC) has been rarely observed in this area. We herein report a rare case of ASC of the EGJ. Case presentation An 81-year-old man visited our hospital complaining of dysphagia. Esophagogastroduodenoscopy detected an elevated tumor in the gastric cardia. Biopsy specimens taken from the tumor showed SCC. Computed tomography revealed a tumor located in the EGJ and node metastases surrounding the EGJ. The tumor was diagnosed as SCC, overhanging in the stomach, of the EGJ. The patient underwent a proximal gastrectomy with a lower esophagectomy and node dissection for the metastases surrounding the EGJ, and esophagogastrostomy in the lower mediastinum. Histopathologic examination showed the tumor consisted of SCC and adenocarcinoma. The adenocarcinoma consisted of nests scattered in the SCC. We observed adenocarcinoma component in 35% of the tumor and epithelial spread of SCC in the lower esophagus. Thus, we diagnosed the tumor as ASC of the EGJ. Eight metastatic nodes were dissected; both SCC and adenocarcinoma were observed in seven. Conclusions In the present case, SCC may be originated from the squamous epithelia of the lower esophagus and grew into the stomach, and the adenocarcinoma may have differentiated from SCC through the infiltration.

Experience with chemotherapy for postoperative metastases of adenosquamous carcinoma of the esophagogastric junction and pathological study of its development

“…There are five developmental hypotheses for ASC of the stomach [ 3 , 4 ]. [ 1 ] squamous transformation of adenocarcinoma, [ 2 ] carcinogenesis of ectopic squamous epithelium, [ 3 ] carcinogenesis of the metaplastic non-neoplastic squamous cells, [ 4 ] differentiation of multipotent undifferentiated cancer cells into both glandular and squamous cells, and [ 5 ] collision of adenocarcinoma and squamous cell carcinoma at the same time.…”

“…On the other hand, there are several hypotheses for the development of ASC of the esophagus [ 1 ] originating from the esophageal intrinsic gland or conduit epithelium, [ 2 ] ASC originating from the mucosa and first developing into SCC, followed by differentiation of the adenocellular cells into adenosquamous cells, [ 3 ] simultaneous collision of AC and SCC [ 1 , 5 , 6 ].…”

“…Adenosquamous carcinoma (ASC) of the esophagus or stomach is reported incidence rates of 0.37–1% among all esophageal cancers in the West and 0.6–1% in Japan [ 1 , 2 ] and reported to be less than 1% of all gastric cancers in Europe and the United States, and 0.14–1.3% in Japan [ 1 , 2 ]. We report a case of ASC of the esophagogastric junction (EGJ) treated with surgery and chemotherapy for metastases and discuss its origin and chemotherapy.…”