title: Fatal submucosal invasive gastric adenosquamous carcinoma detected at surveillance after gastric endoscopic submucosal dissection.
abstract: An 80-year-old man was under annual surveillance esophagogastroduodenoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Two years after the initial ESD, a 0-IIc type metachronous EGC lesion, 8 mm in size, without an ulcer scar, was found in the gastric antrum. The estimated tumor depth was up to the mucosa, and biopsy revealed well and poorly differentiated adenocarcinoma. ESD was performed for this lesion and en bloc resection with negative margins was achieved. Histopathological examination revealed an adenosquamous carcinoma 8 mm in size invading the deep submucosal layer (1600 μm), with lymphovascular invasion, consistent with the diagnosis of non-curative resection. Additional gastrectomy was recommended for this patient; however, two months after the ESD, preoperative computed tomography revealed multiple liver metastases, and the patient was considered as an unsuitable candidate for surgical resection. Systemic chemotherapy was therefore started; however, the patient died of gastric cancer 27 mo after the second ESD. Early gastric adenosquamous carcinoma localized to the mucosa and submucosa is extremely rare and its clinical behavior is not well known. The present report is very significant in that it underscores the distinct possibility of gastric adenosquamous carcinoma being very aggressive and fatal even when detected at an early cancer.
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Shirahige
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Masau
authors.initials: M
authors.lastname: Sekiguchi
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Genki
authors.initials: G
authors.lastname: Mori
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Abe
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Nonaka
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Yoshinaga
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Sekine
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kushima
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Fukagawa
authors.affiliation: Akinori Shirahige, Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Genki Mori, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Katai
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D018196:Carcinoma, Adenosquamous / Q000737:chemistry / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D004210:Dissection / Q000379:methods*; D055088:Early Detection of Cancer; D016145:Endoscopy, Digestive System; D017809:Fatal Outcome; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D009361:Neoplasm Invasiveness; D016609:Neoplasms, Second Primary / Q000737:chemistry / Q000473:pathology*; D012086:Reoperation; D013274:Stomach Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor
keywords: Early gastric cancer; Endoscopic submucosal dissection; Gastric adenosquamous carcinoma; Gastric cancer-related death; Liver metastasis; Metachronous cancer; Surveillance