Case Presentation Dr Nabila Al-Julandani Armed Forces Hospital Case - - PowerPoint PPT Presentation

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Case Presentation Dr Nabila Al-Julandani Armed Forces Hospital Case - - PowerPoint PPT Presentation

May 26, 2023 43 likes •485 views

Case Presentation Dr Nabila Al-Julandani Armed Forces Hospital Case 39 years old lady Present in July 2016 : history of epigastric pain, nausea, weight loss and anemia. Past history: In February 2016: radical hysterectomy for

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Case Presentation

Dr Nabila Al-Julandani Armed Forces Hospital

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Case

  • 39 years old lady
  • Present in July 2016 : history of epigastric pain, nausea,

weight loss and anemia.

  • Past history:

– In February 2016: radical hysterectomy for cervical cancer.

  • Family history:

– Positive for uterine and gastrointestinal carcinoma.

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Case

  • CT scan abdomen:

– Large irregular fungating mass of the gastric fundus infiltrating the splenic hilum, splenic vessels with large area of lower pole splenic infarction. – The gastroesophageal junction looks unremarkable. – No significant lymphadenopathy or peritoneal deposits. – No liver or lung metastasis.

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Gross

  • Gastresophagectomy with enblock resection
  • f spleen, distal pancreas and part of

diaphragm.

  • Polypoid ulcerated tumor in the fundus and

upper body.

  • The tumor was 5 cm from proximal margin.
  • The tumor infiltrates spleen and diaphragm.
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Gastroesophagectomy with enblock resection of spleen, distal pancreas and diaphragm

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MICROSCOPY

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Summary

  • Squamous cell carcinoma.
  • No intestinal or squamous metaplasia
  • 30 lymph nodes with no evidence of metastatic tumor.
  • Perineural and vascular invasion present.
  • Proximal and distal resection margins are free of tumor.
  • Gastroesophageal junction is free of tumor.
  • Tumor infiltrates spleen, diaphragm and peripancreatic

tissue.

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Diagnosis

  • Moderately to poorly differentiated squamous

cell carcinoma involving the stomach ( fundus and upper body ), spleen and diaphragm.

  • Primary ?? Metastasis ??
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  • Primary gastric SCC :

– Nests of squamous epithelium in gastric mucosa – Squamous metaplasia of gastric mucosa. – Multipotent stem cell in gastric mucosa. – Squamous differentiation of pre-existing adenocarcinoma.

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Cervical Cancer

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IMMUNOHISTOCHEMISTRY

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  • The tumor cells positive for

▪ Ck5/6 ▪ P16 ▪ p63 ▪ p53

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Diagnosis

  • Metastatic moderately to poorly differentiated

squamous cell carcinoma from cervix to stomach, spleen and diaphragm.

  • Stage ??
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  • Cervical squamous cell carcinoma,

( FIGO stage IV )

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Discussion

  • Gastric cancer is the fourth most common

type of malignancy.

  • Adenocarcinoma is the most common

histologic type ( >90% ) .

  • Either metastatic or primary squamous cell

carcinoma in the stomach is extermely rare.

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Discussion

  • Very few cases reported in literature.
  • Pure primary squamous cell carcinoma of stomach is

very rare.

  • Common in elderly
  • M:F ratio is 5:1.
  • The primary is more common than secondary.
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  • Stomach is an unusual site for metastasis.
  • The primary site: esophagus, skin, lung and

breast.

  • Most Metastatic SCC to stomach are from lung

primary.

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Discussion

  • In cervix, SCC accounts to 80-85%.
  • It can occurs at any age.
  • Most common metastatic sites - direct extension to

contiguous structures.

  • 50% of stage IV - distant metastasis.
  • Common sites : liver, lung, bone marrow.
  • GIT is 8%.
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Discussion

  • Common sites : rectum.
  • Gastric lesion : <2%.
  • Spread: lymphatics (para-aortic or mesenteric nodes to

gastric serosa.

  • blood stream.
  • Peritoneal seedlings.
  • Splenic metastasis – multiple organ mets.
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Conclusion

  • Primary and secondary SCC of stomach is

extremely rare.

  • Extra-pelvic spread of cervical SCC to the

stomach is uncommon.

  • Accurate recognition of such unusual pattern
  • f metastasis is important for therapeutic

decision.

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