P3401 - Gastric Squamous Cell Carcinoma a Rare Entity Presenting as Encephalopathic Anemia

Anudeep Jala, DO¹, Rahul Patel, DO¹, Christopher Chhoun, DO¹, Matthew Everwine, DO¹, C. Jonathan Foster, DO^2
1Jefferson Health, Washington Township, NJ; ²Jefferson Health, Cherry Hill, NJ

Introduction: Squamous cell carcinoma of the stomach is a rare type of gastric cancer. It is more aggressive than adenocarcinoma due to its higher risk of lymph node/serosal invasion and often presents in advanced stages. We present a case of squamous cell carcinoma in a patient who initially presented with encephalopathy.

Case Description/Methods: A 60-year-old male with a past medical history of type 2 diabetes presented to the hospital for concern of altered mental status and increasing lethargy for the past few weeks. Family noted significant weight loss over the past year and minimal oral intake in recent weeks. He has no prior history of smoking, alcohol, or recreational drugs. No prior esophagogastroduodenoscopy (EGD) or colonoscopy was conducted. Hemoglobin on admission was 4.5 g/dL. Initial albumin, bilirubin and remainder of liver function tests (LFTs) were within normal limits. Computed tomography (CT) head was unremarkable. CT abdomen and pelvis with contrast demonstrated massive gastric distention with apple core type tumor of the pylorus and proximal duodenum causing obstruction.



Patient underwent EGD which demonstrated an ulcerated, fungating mass of the antrum, resulting in complete gastric obstruction. The scope was then passed through the antrum with fluoroscopic guidance and an uncovered self-expandable metal stent (USEMS) duodenal stent was placed with appropriate contrast filling of the small bowel. Antral mass biopsy had returned as invasive carcinoma consistent with squamous cell carcinoma. As the patient received subsequent red blood cell and iron transfusions his mentation had improved. This carcinoma had likely resulted in indolent and chronic iron deficiency anemia. Our patient was deemed stable for outpatient follow-up with Hematology/Oncology for outpatient PET-CT scan to assess burden of disease.

Discussion: Squamous cell carcinoma is a rare gastric malignancy that is aggressive and often found in advanced stages. Of the various subtypes of gastric cancer, squamous cell carcinoma has an incidence of 0.04-0.07%. Prompt identification of the cancer can guide chemotherapy and surgical interventions. Our case is unique as this rare cancer presented itself initially as encephalopathy secondary to anemia. Unfortunately, given its indolent nature and aggressive metastasis, squamous cell carcinoma generally has poor short-term prognosis.



Disclosures:


Anudeep Jala, DO¹, Rahul Patel, DO¹, Christopher Chhoun, DO¹, Matthew Everwine, DO¹, C. Jonathan Foster, DO². P3401 - Gastric Squamous Cell Carcinoma a Rare Entity Presenting as Encephalopathic Anemia, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.