
==== Front
Gastro Hep Adv
Gastro Hep Adv
Gastro Hep Advances
2772-5723
Elsevier

S2772-5723(24)00089-X
10.1016/j.gastha.2024.06.008
Images of the Month
Gastric Adenosquamous Carcinoma Mimicking Pancreatic Cancer
Kubo Kimitoshi kubotti25@yahoo.co.jp
1∗
Ashida Issei 1
Kimura Noriko 2
1 Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Hokkaido, Japan
2 Department of Pathology, National Hospital Organization Hakodate National Hospital, Hakodate, Hokkaido, Japan
∗ Correspondence: Address correspondence to: Kimitoshi Kubo, MD, PhD, Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, 18-16 Kawahara-cho, Hakodate 041-8512, Hokkaido, Japan. kubotti25@yahoo.co.jp
28 6 2024
2024
28 6 2024
3 7 881882
15 4 2024
20 6 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcA 74-year-old man was referred to our hospital with suspected pancreatic tumor. Computed tomography revealed a 15-cm tumor in the upper abdomen and gastric wall invasion with nonuniform contrast enhancement (Figure A). The pancreatic body and tail were found to be unclear, and pancreatic cancer (PC) was suspected (Figure B). Endoscopic ultrasound fine-needle aspiration not only revealed poorly differentiated adenocarcinoma but also depicted a new gastric ulcer on the posterior wall of the gastric body, not detected on esophagogastroduodenoscopy performed 1 month earlier, suggesting gastric wall invasion (Figure C). He was diagnosed with PC and died 1 month after undergoing chemotherapy (gemcitabine plus nab-paclitaxel). His rapid clinical course prompted an autopsy, which led to the case being diagnosed with gastric adenosquamous carcinoma (GASC), that is, a huge mass involving necrosis, hemorrhage, and cystic degeneration associated with peritoneal carcinomatosis and direct tumor invasion to the duodenum, liver, and colon (Figure D).

GASC is a rare aggressive tumor with poor prognosis that accounts for less than 1% of all gastric carcinomas. The radiologic and endoscopic images presented here should clearly demonstrate how advanced GASC may invade the surrounding organs extramurally and may thus be misdiagnosed as PC and serve as a reference for gastroenterologists.

Conflicts of Interest: The authors disclose no conflicts.

Funding: The authors report no funding.

Ethical Statement: The study did not require the approval of the Institutional Review Board of Hakodate National Hospital.

Reporting Guidelines: CARE.
