TY - JOUR
T1 - Gastric adenosquamous carcinoma with an apparently pure squamous phenotype on limited biopsy in a patient with HIV
T2 - A case report
AU - Youssef, Mohamed A.
AU - Chaharsoughi, Zahra Sarrafan
AU - Wagner, Celeste E.
AU - Ghani, Hafiz
AU - Parupudi, Sreeram
AU - Nawgiri, Ranjana
N1 - Publisher Copyright:
© The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
PY - 2026/1/1
Y1 - 2026/1/1
N2 - Gastric carcinomas with squamous differentiation are exceptionally rare and diagnostically difficult, particularly on limited biopsy material. We report a case of an HIV-positive man in his mid-60s who presented with abdominal pain, melena, and unintentional weight loss. Initial upper endoscopy revealed a large, ulcerated mass involving the gastric fundus and cardia; superficial endoscopic biopsies were non-diagnostic. Endoscopic ultrasound–guided biopsy demonstrated invasive squamous cell carcinoma without a glandular component, and the tumor was staged cT4b cN1 cM0 (clinical Stage IVA, AJCC/UICC eighth edition). The biopsy interpretation was treated as provisional, since sampling of this extent cannot exclude a glandular component. After neoadjuvant FLOT chemotherapy, total gastrectomy with multivisceral resection yielded gastric adenosquamous carcinoma with hepatic metastatic adenocarcinoma, establishing M1 disease and Stage IV. A pure squamous phenotype in a gastric biopsy is therefore not sufficient to diagnose primary gastric squamous cell carcinoma; the distinction rests on the resection specimen. The patient’s HIV infection is relevant background rather than a demonstrated cause.
AB - Gastric carcinomas with squamous differentiation are exceptionally rare and diagnostically difficult, particularly on limited biopsy material. We report a case of an HIV-positive man in his mid-60s who presented with abdominal pain, melena, and unintentional weight loss. Initial upper endoscopy revealed a large, ulcerated mass involving the gastric fundus and cardia; superficial endoscopic biopsies were non-diagnostic. Endoscopic ultrasound–guided biopsy demonstrated invasive squamous cell carcinoma without a glandular component, and the tumor was staged cT4b cN1 cM0 (clinical Stage IVA, AJCC/UICC eighth edition). The biopsy interpretation was treated as provisional, since sampling of this extent cannot exclude a glandular component. After neoadjuvant FLOT chemotherapy, total gastrectomy with multivisceral resection yielded gastric adenosquamous carcinoma with hepatic metastatic adenocarcinoma, establishing M1 disease and Stage IV. A pure squamous phenotype in a gastric biopsy is therefore not sufficient to diagnose primary gastric squamous cell carcinoma; the distinction rests on the resection specimen. The patient’s HIV infection is relevant background rather than a demonstrated cause.
KW - HIV-associated malignancy
KW - endoscopic ultrasound–guided biopsy
KW - gastric adenosquamous carcinoma
KW - immunosuppression
KW - primary gastric squamous cell carcinoma
UR - https://www.scopus.com/pages/publications/105049255104
UR - https://www.scopus.com/pages/publications/105049255104#tab=citedBy
U2 - 10.1177/2050313X261486169
DO - 10.1177/2050313X261486169
M3 - Article
C2 - 42694278
AN - SCOPUS:105049255104
SN - 2050-313X
VL - 14
JO - SAGE Open Medical Case Reports
JF - SAGE Open Medical Case Reports
ER -