P2512 - Gastric Squamous Cell Carcinoma as a Rare Cause of Gastrointestinal Bleeding

Theodore Moore, MD, Omar Martinez-Uribe, MD, Alyson Johnson, MD, Joshua Lee, MD, Cynthia Guy, MD
Duke University Hospital, Durham, NC

Introduction: Gastric squamous cell carcinoma (GSCC) is rare and accounts for less than 1% of gastric malignancies. Due to its rarity, specifics regarding the clinical presentation and risk factors for this malignancy are still uncertain. Gastric cancer can present with gastrointestinal (GI) bleeding ranging from occult bleeding to overt hemorrhage. We describe a rare case of a primary GSCC that presented with unstable GI bleeding.

Case Description/Methods: A 64-year-old female with a history of vertical banded gastroplasty and orthotopic liver transplant for primary biliary cholangitis (PBC) presented to an outside hospital with melena and hypovolemic shock. Due to her history of liver transplant, she was transferred to a tertiary care facility. Following resuscitation, upper endoscopic evaluation was completed. This revealed a vertical banded gastroplasty with large amounts of clotted blood within the stomach. After clearance of blood products, an ulcerated, oozing gastric mass was seen within the fundus of the excluded stomach. The mass was biopsied and treated with hemostatic spray with successful hemostasis.

Discussion: The biopsies were diffusely positive for squamous markers p63, p40, and keratin and negative for lung-related markers TTF-1 and NAPSI. Additionally, an adenocarcinoma marker, MOC31, was negative. Given the molecular markers, the pathology was consistent with GSCC. This case highlights that GI luminal bleeding can present as the primary symptom of gastric malignancy, and even rare tumors such as GSCC should remain on the differential. This case also highlights the importance of sampling gastric masses, even when concurrent bleeding is present, as unexpected pathology may be found.



Disclosures:


Theodore Moore, MD, Omar Martinez-Uribe, MD, Alyson Johnson, MD, Joshua Lee, MD, Cynthia Guy, MD. P2512 - Gastric Squamous Cell Carcinoma as a Rare Cause of Gastrointestinal Bleeding, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.