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Background/aim: Laparoscopic gastrectomy (LG) is more frequently associated with postoperative liver enzyme elevation (PLEE) than open gastrectomy in phase III clinical trials for Japanese gastric cancer patients. The aim of this study was to determine the risk factors for PLEE after LG for gastric cancer., Patients and Methods: This study enrolled 153 consecutive patients with gastric cancer who underwent LG. The patient characteristics, the liver retraction method [silicone disc (SD) or Nathanson liver retractor (NLR)], and perioperative outcomes were compared between patients with and without PLEE., Results: PLEE was observed in 26 patients (17%). The patients with PLEE exhibited longer operative times (p=0.005) and more frequent use of the NLR for liver retraction (p=0.022). In the multivariate analysis, liver retraction using the NLR (p=0.003) and aberrant left hepatic artery (ALHA) ligation (p=0.042) were independent risk factors of PLEE., Conclusion: Liver retraction with the SD during LG was shown to be the safer method that is less likely to cause postoperative liver dysfunction. ALHA preservation may contribute to avoiding postoperative liver dysfunction., (Copyright© 2021, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: DNA mismatch repair (MMR) deficiency has received increasing attention as a biomarker of anti-PD-1 treatments of solid tumors including gastric cancer (GC). However, efficient screening has not been established., Patients and Methods: A total of 513 patients were tested for the expression of MMR proteins by immunohistochemistry to identify MMR deficient GC. Development of a prediction model was attempted using the common clinicopathological features., Results: In total, 11% (57/513) of the patients showed loss of expression of either one or more MMR proteins (MMR protein deficiency; MMR-D). Multivariate analysis demonstrated that age (≥70 years), sex (female), tumor location (lower 1/3), depth invasion (low, T1/T2/T3), and absence of distant metastasis were significantly independent predictive factors of MMR-D GCs. The MMR-D GC probability estimated by the prediction model ranged from 0.4% to 62.2%, and the area under the curve of the receiver operating characteristics curve was 0.82 (95% confidence interval=0.75-0.87)., Conclusion: Our prediction model can sufficiently and efficiently identify MMR-D GCs using clinical features., (Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Aim: To evaluate the efficacy and safety of third-line chemotherapy (CTx) for patients with unresectable or recurrent gastric cancer (GC) refractory to S-1 with or without platinum and taxanes., Patients and Methods: We retrospectively analyzed clinicopathological and survival data of 26 patients who underwent third-line CTx., Results: Irinotecan therapy (odds ratio=0.12, 95% confidence interval=0.02-0.38; p<0.01) and ≥2 cycles of third-line CTx (odds ratio=0.01, 95% confidence intervaI=0.01-0.11; p<0.01) were independent predictors of longer progression-free survival in multivariate Cox regression analysis. In 18 patients (69%) receiving irinotecan, the overall response rate was 11%, and the disease control rate was 44%. Median progression-free and overall survival were 3.5 and 11.3 months, respectively. Ten patients (56%) had grade 3-4 toxicities, which were managed., Conclusion: Irinotecan therapy may become optimal and tolerated in the third-line setting to prolong progression-free survival by increasing the number of treatment cycles., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Advances in chemotherapy for gastric cancer have encouraged surgeons to perform conversion surgery following a response to first-line chemotherapy in patients with initially unresectable gastric cancer. In this study we evaluated the efficacy of conversion surgery following first- or second-line chemotherapy for unresectable gastric cancer., Patients and Methods: We retrospectively analyzed clinicopathological and survival data of 94 patients with unresectable gastric cancer treated with first- (n=94) or second-line (n=43) chemotherapy., Results: Patients who converted to surgery following first- (n=26) or second-line (n=5) chemotherapy had significantly longer survival times than those treated with chemotherapy alone (n=63) (p<0.01). Survival length did not differ significantly between patients converted to surgery following first- and second-line chemotherapy. Among 31 patients who underwent conversion surgery, one initial non-curative factor (odds ratio(OR)=0.49; 95% confidence interval (95%CI)=0.22-0.95; p=0.03) was the only significant independent predictor of longer survival in multivariate Cox regression analysis., Conclusion: Patients with unresectable gastric cancer initially exhibiting one noncurative factor may obtain survival benefit from conversion surgery after a response to both first- and second-line chemotherapy., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

This retrospective study evaluated an appropriate surgical treatment in patients with perforated gastric cancer. The clinicopathological and survival data on 17 perforated gastric cancer patients treated with surgery were analyzed. The one-stage or two-stage gastrectomy was performed in 8 and 5 patients, respectively. The omental patch repair was performed in 4 patients. In univariate analysis, non-curative(R2)resection with gross residual tumor(p<0.01)and postoperative complications( p=0.01)were found to be significant unfavorable factors for overall survival(OS). In multivariate analysis, R2 resection was identified to be an only independent significant unfavorable factor for OS. Patients who underwent curative(R0) resection had long-term survival, while patients with R2 resection and postoperative complication had limited survival times. These results suggest that R0 resection may be optimal to improve survival in patients with perforated gastric cancer, regardless of whether patients underwent a one-stage or two-stage gastrectomy based on the patient's condition.

Background/aim: We evaluated the survival benefit of splenectomy in patients with esophagogastric junction (ECJ) carcinoma., Patients and Methods: We retrospectively examined clinicopathological and survival data for 60 surgically-treated patients with ECJ carcinoma., Results: The 5-year overall survival (OS) rate was 47%. Splenectomy was performed in 20 patients (30%). Multivariate Cox regression analysis revealed splenectomy (odds ratio (OR), 2.70; 95% confidence interval (CI)=1.06-7.17; p=0.04) and venous invasion (OR=3.03; 95%CI=1.20-9.27; p=0.02) as significant independent predictors of poorer OS. Splenic hilar lymph node metastasis was not observed. Multivariate logistic regression analysis identified perioperative blood transfusion (BTF) as a significant independent factor associated with splenectomy., Conclusion: The survival benefit of splenectomy in ECJ carcinoma patients may decrease with increasing frequency of perioperative BTF for blood loss. We recommend that splenectomy should be performed carefully when indicated by the extent or invasion of EGJ carcinoma., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: To evaluate the efficacy of conversion surgery following S-1 plus cisplatin (CS) or oxaliplatin (SOX) chemotherapy., Patients and Methods: We retrospectively analyzed clinicopathological and survival data of 74 patients with unresectable gastric cancer receiving CS or SOX., Results: Fifty-five and nineteen patients received CS and SOX, respectively. Conversion surgery (odds ratio (OR), 0.17; 95% confidence interval (CI), 0.04-0.64; p=0.01) was the only significant independent predictor of longer survival in multivariate Cox regression analysis. Patients (median age, 74 years) receiving SOX were significantly older than those receiving CS (median age=67 years) (p<0.01), although the rates of response, severe toxicity or conversion surgery did not differ significantly between the two treatment groups., Conclusion: Conversion surgery after a response to CS or SOX chemotherapy may have survival benefit in selected unresectable gastric cancer patients, for both non-elderly and elderly patients responding to SOX., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background and study aims  We report the features of a newly developed endocytoscopy system (ECS), the GIF-Y0074. Patients and methods  The GIF-Y0074 offers high-definition resolution with a consecutive increase of magnification to × 500. Using ECS, we observed 32 cases of esophageal squamous cell carcinoma (ESCC), 11 cases of gastric cancer, and five cases of duodenal adenoma. Results  The images of cells obtained using the GIF-Y0074 at maximum magnification were brighter and clearer than those obtained with previous ECS systems. For diagnosis of ESCC, clearer visualization of the nucleus made nuclear abnormality easier to recognize. Cancer cells were visualized in 10/11 cases of gastric cancer, but removal of mucus still remained a problem. Duodenal adenomas were found to have atypical cells with villi and tubules at the mucosal surface, thus assisting their histological diagnosis in vivo. Conclusion  The GIF-Y0074 is an excellent ECS in terms of ease of use, satisfactory resolution, and magnification power, and therefore achieves a level of utility that makes its commercial release justifiable. This ECS heralds a new era of endoscopic and histological diagnosis., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: To evaluate the efficacy and safety of nanoparticle albumin-bound-paclitaxel (nab-PTX) as second-line chemotherapy (CT) for patients with unresectable or recurrent gastric cancer (GC)., Patients and Methods: The clinicopathological and survival data of 37 patients with unresectable or recurrent GC who underwent nab-PTX monotherapy as second-line CT, were retrospectively analyzed., Results: The median number of cycles and relative dose intensity administered per patient were 5 and 90%, respectively. Their overall response rate was 24.3% and the disease control rate was 59.5%. Median progression-free survival (PFS) and overall survival were 4.8 months and 10.4 months, respectively. Thirteen patients had grade 3 or 4 toxicities and were managed. In multivariate Cox regression analysis, cycles of chemotherapy ≥5 (odds ratio, 0.20; 95% confidence interval, 0.08-0.50; p<0.01) was the only significant independent predictor of longer PFS., Conclusion: Nab-PTX may effectively prevent disease progression as second-line CT by increasing treatment cycles and managing adverse effects., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

This report describes a patient with unresectable advanced gastric cancer who was successfully treated with potentially curative conversion surgery after chemotherapy with S-1 plus oxaliplatin(SOX). An 82-year-old man was diagnosed with type 5 gastric cancer(por1, HER2-negative)with multiple granular mucosal necroses that had metastasized throughout his body. Computed tomography revealed multiple lymph node metastases, tumor thrombosis in the splenic and portal veins, and peritoneal dissemination. After 9 courses of first-line chemotherapy with SOX, there was no tumor thrombosis in the splenic and portal veins or peritoneal dissemination, and the primary tumor and lymph node metastases were markedly reduced in size, indicative of a partial response(PR). The patient subsequently underwent total gastrectomy as curative conversion surgery. The histological diagnosis was ypT2N0M0, ypStage I B, and the primary lesion was categorized as Grade 2 gastric cancer. At present, 1 year after surgery, the patient remains alive without tumor recurrence.

The loss of mismatch repair(MMR)function as a result of MLH1 promoter methylation is closely correlated with high frequency microsatellite instability, and tumors with such characteristics are resistant to anticancer drugs such as 5-FU. We examined the incidence and characteristics of deficient MMR(dMMR)in elderly gastric cancer patients by performing a comprehensive immunohistochemical screening. The study was conducted in 199 patients diagnosed with gastric cancer, aged 75 years or older, who underwent a gastrectomy between April 2005 and January 2014. dMMR was detected in 23 patients(12%). All the tumors with dMMR were deficient in MLH1 and PMS2. dMMR was significantly more common compared to proficient MMR(pMMR)in patients with a more advanced age(p=0.03), women(p<0.01), and a tumor location corresponding to the lower region(p<0.01). Considering the incidence of dMMR in elderly gastric cancer patients, only a limited proportion of patients are likely to be eligible for immune checkpoint inhibitor therapy, which is expected to become more popular in the near future.

Aim: To evaluate the efficacy of protein-bound polysaccharide K (PSK) added to S-1 adjuvant chemotherapy for treatment of advanced gastric cancer., Patients and Methods: We retrospectively examined clinicopathological and recurrence-free survival (RFS) data for 136 patients with stage II or III advanced gastric cancer who underwent S-1 adjuvant chemotherapy with or without PSK., Results: Among 13 clinicopathological factors, non-T4 stage (odds ratio (OR)=0.61; 95% confidence interval (CI)=0.41-0.89; p<0.01), N0-1 (OR=0.65; 95% CI=0.43-0.95; p=0.03) and number of treatment cycles ≥7 (OR=0.37; 95% CI=0.20-0.67; p<0.01) were significant independent factors for better RFS. The number of treatment cycles of S-1 plus PSK was significantly higher than that of S-1 alone (p<0.01)., Conclusion: S-1 adjuvant chemotherapy combined with PSK may reduce recurrence by prolonging the treatment cycles in patients with advanced non-T4 or N0-1 gastric cancer., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: To identify the prognostic factors for gastric cancer with positive peritoneal cytology (CY1) or peritoneal metastasis (P1)., Patients and Methods: We retrospectively analyzed clinicopathological and survival data of 78 patients who had undergone gastrectomy and/or S-1 based chemotherapy for CY1 or P1 gastric cancer., Results: The median overall survival (OS) did not differ significantly between patients with CY1P0, CY0P1 and CY1P1 disease (24, 17 vs. 14 months, respectively). Among 12 clinicopathological factors, clinical N3 (odds ratio [OR]=2.18; 95% confidence interval [CI]=1.22-4.00; p=0.01) and gastrectomy not performed (OR=1.80; 95% CI=1.29-2.51; p<0.01) were significant independent prognostic factors. The median OS significantly differed between patients who had undergone gastrectomy plus chemotherapy versus chemotherapy alone (22 vs. 10 months, respectively; p<0.01)., Conclusion: Gastrectomy and perioperative chemotherapy may both be indicated in CY1 or P1 gastric cancer patients with clinical N0-2., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: To evaluate the recurrence risk after curative conversion surgery following chemotherapy for initially unresectable gastric cancer., Patients and Methods: We retrospectively analyzed clinicopathological and postoperative recurrence-free survival (RFS) data for 34 patients who underwent curative conversion surgery., Results: Recurrence was observed in 17 (50%) patients, with a median time to recurrence of 22 months (range=1-98 months). In nine (53%) patients with recurrence, the pattern was consistent with their initial metastatic disease. According to multivariate Cox regression analysis, initial clinical T4b disease (cT4b; odds ratio=6.44, 95% confidence interval=1.59-23.9; p=0.01) was the only significant independent risk factor affecting RFS. Pathological T4a or T4b disease was recorded in five-out of six (83%) patients with cT4b., Conclusion: Initial cT4b disease appears to predict recurrence in patients with initially unresectable gastric cancer treated with curative conversion surgery. Effective use of additional chemotherapy may be required for patients with this risk factor., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background: The prognosis of unresectable gastric cancer is poor. Chemotherapy occasionally converts an initially unresectable gastric cancer to a resectable cancer., Methods: The responses of noncurative factors to initial chemotherapy and the outcomes of additional (conversion) surgery were retrospectively evaluated in 151 patients with unresectable gastric cancer receiving combination chemotherapy with S-1 plus cisplatin or paclitaxel from February 2003 to December 2013., Results: Forty (26 %) of 151 patients underwent conversion surgery. After chemotherapy, R0 resection was accomplished in 32 patients (80 %). The 5-year overall survival (OS) rate among the 40 patients who underwent conversion surgery was 43 % (median survival time, 53 months). The 5-year OS rate in the 111 patients treated with chemotherapy alone was 1 % (median survival time, 14 months). Patients who underwent conversion surgery had significantly longer OS times than patients who underwent chemotherapy alone (P < 0.01). The 5-year OS rate among patients who underwent R0 resection was 49 % (median survival time, 62 months). Patients who underwent R0 resection had significantly longer OS times than those who underwent R1 and R2 resection (P = 0.03). Among patients who underwent conversion surgery, multivariate Cox regression analysis showed that one noncurative factor (odds ratio 0.49; 95 % confidence interval 0.28-0.88; P = 0.02) and R0 resection (odds ratio 0.52; 95 % confidence interval 0.28-0.95; P = 0.03) were significant independent predictors for favorable OS., Conclusions: Patients with unresectable gastric cancer initially exhibiting one noncurative factor may obtain a survival benefit from chemotherapy and subsequent curative surgery.

Aim: To evaluate the recurrence risk for Siewert type II esophagogastric junction carcinoma treated with curative resection., Patients and Methods: We retrospectively analyzed clinicopathological and recurrence-free survival (RFS) data of 52 patients after curative resection for Siewert type II carcinoma focusing on the role of lymph node metastasis around the greater curvature or parapyloric area., Results: Recurrence was observed in 21 (40%) patients; the median time-to-recurrence was 11 months (range=3-33 months). According to multivariate Cox proportional hazard regression analysis, involvement of nodes no. 4sa, 4sb, 4d, 5 and/or 6 (odds ratio (OR)=6.62; 95% confidence interval (CI)=1.27-41.1; p=0.04) and younger age (OR=2.10; 95% CI=1.25-3.82; p<0.01) were significant independent risk factors affecting RFS., Conclusion: Involvement of no. 4-6 nodes appears to predict recurrence of Siewert type II carcinoma treated with curative resection. Patients with this risk factor may benefit from effective use of perioperative chemotherapy., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

This retrospective study identified the optimal treatment strategy for patients with gastric cancer with positive peritoneal cytology. We analyzed clinicopathologic and survival data for 54 patients who had undergone gastrectomy and/or chemotherapy for treatment of gastric cancer with positive peritoneal cytology with (n = 40) or without (n = 14) metastatic disease. The median overall survival did not differ significantly between patients with gastric cancer with positive peritoneal cytology with and without metastatic disease (19 versus 13 months, respectively). Among 14 clinicopathologic variables, the lack of gastrectomy was the only significant independent unfavorable factor for survival (odds ratio, 1.64; 95% confidence interval, 1.04-2.57; P = 0.03). The median overall survival significantly differed among patients who had undergone gastrectomy plus chemotherapy, chemotherapy alone, and gastrectomy alone (25, 10, and 17 months, respectively; P < 0.01). Gastrectomy may be optimal for patients with (gastric cancer with positive peritoneal cytology), considering its favorable prognostic effect with respect to perioperative chemotherapy.

The aim of this study was to evaluate clinicopathological variables, including the granulocyte-to-lymphocyte ratio(G/L ratio), as prognostic factors for Stage IV gastric cancer patients. A total of 70 patients treated for Stage IV gastric cancer were enrolled in this study. Univariate analysis indicated that age ≥70 years, performance status >2, resection not being performed, chemotherapy not being administered, high C-reactive protein(CRP)levels, and carbohydrate antigen 19-9 levels were significantly associated with poor survival. Multivariate analysis of these factors identified resection not being performed, chemotherapy not being administered, and high CRP levels as independent unfavorable factors of survival. Although the G/L ratio was not a prognostic factor for Stage IV gastric cancer patients in this study, further studies with greater number of patients are required to determine whether the G/L ratio is a significant biomarker associated with survival.

Purpose: This retrospective study evaluated immunity in elderly patients with unresectable gastric cancer receiving S-1/ Lentinan combination chemotherapy., Patients and Methods: This study included 10 patients aged≥70 years with unresectable gastric cancer who received S-1/Lentinan combination chemotherapy between October 2008 and December 2012. All patients gave written informed consent. Immune parameters for regulatory T cell(Treg)ratio, prostaglandin E2(PGE2), C3, CH50, and granulocyte/lymphocyte ratio were measured before chemotherapy initiation and at 7 weeks after it. Clinicopathological or immune parameters affecting overall survival(OS)were consequently evaluated., Results: A high Treg ratio(p=0.02) and low PGE2(p=0.05)levels at 7 weeks after chemotherapy and a decrease in the Treg ratio(p=0.02)were found to be significant favorable factors affecting OS., Conclusion: The outcome of elderly patients with unresectable gastric cancer receiving S-1/Lentinan combination chemotherapy seemed to be correlated with the change in immunity.

Background: The primary aim of this study was to examine the motor activity (motility) of a gastric tube after laparoscopic-assisted proximal gastrectomy (LPG). A secondary objective was to ascertain whether a correlation exists between gastric tube motor activity and reflux esophagitis., Patients and Methods: A total of 41 patients who underwent LPG for early gastric cancer were studied. The motility of the gastric tube and the status of reflux esophagitis were evaluated. Manometric recording was performed 2 weeks and 1 year after surgery., Results: In a fasting state, the motilities of the distal gastric tube and duodenum recovered within 1 year after surgery but that of the proximal gastric tube did not recover. Improvement of the motility of the gastric tube was associated with a decreased number of patients with reflux esophagitis 1 year after surgery. In patients with reflux esophagitis, the motility of the distal gastric tube was significantly lower than that in patients without reflux esophagitis., Conclusion: After LPG, the motility of the gastric tube recovered, and the incidence of reflux esophagitis decreased with time, in parallel to recovery of gastrointestinal motility., (Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

A 59-year-old Japanese man was admitted to our hospital because of a 1-month history of dysphagia. Endoscopic examination revealed a superficial esophageal squamous cell carcinoma and a giant gastric tumor. Computed tomography showed that the gastric tumor was directly invading the liver and pancreas. Because of the risk of the gastric tumor causing obstruction and bleeding, we performed a subtotal esophagectomy, proximal gastrectomy, left lateral segmentectomy of liver, and pancreatosplenectomy with gastric tube reconstruction. Final pathological findings were superficial esophageal carcinoma penetrating the muscularis mucosae with an intramural gastric metastasis directly invading the liver and pancreas. The patient received postoperative adjuvant chemotherapy, yet died 8 months postoperatively of complications of local recurrence. Early-stage esophageal carcinoma with intramural gastric metastasis is very rare. To our knowledge, this is the first case of mucosal esophageal carcinoma with intramural gastric metastasis directly invading other organs.

Background/aim: To evaluate the potential risk of gastric tube reconstruction for Siewert type II esophagogastric junction carcinoma., Patients and Methods: We retrospectively analyzed clinicopathological and survival data of 41 patients who had undergone total gastrectomy for Siewert type II carcinoma, focusing on lymph node metastasis around the middle to lower greater curvature or parapyloric area., Results: Histological examination showed involvement of at least one lymph node in six patients (14%). Multivariate Cox proportional hazard regression analysis of seven clinicopathological variables showed that lymph node metastasis around the middle to lower greater curvature, or parapyloric area was the only significant independent unfavorable factor (odds ratio=6.62; 95% confidence interval=1.27-41.1; p=0.03) for survival. We identified no significant predictors of lymph node metastasis in analyzed patients., Conclusion: From an oncological point of view, we do not recommend routine gastric tube reconstruction for Siewert type II carcinoma.

Background/aim: We aimed to clarify the roles of CRP and albumin as independent prognostic factors for stage IV gastric cancer (stIVGC) patients. The optimal cut-off value for these two markers was investigated., Patients and Methods: 123 stIVGC patients presented at our Medical Center from April, 2005 to March, 2011 were investigated. Clinicopathological, tumor-specific and treatment factors were analyzed. Univariate and multivariate Cox proportional regression models were used to identify for favorable factors affecting overall survival. The Receiver operating characteristic (ROC) curve was utilized to determine cut-off values., Results: Multivariate analysis revealed CRP (hazard ratio (HR): 1.11; 95% confidence interval (CI): 1.03-1.18) to be an independent prognostic factor for survival. According to the results of the analysis albumin was excluded. ROC curve of the 3-month-prognosis patients revealed a maximum area under the curve of 0.85 and a cut-off value of 1.7 mg/dl., Conclusion: CRP can be considered an independent prognostic factor for survival of stIVGC patients and can be used for short-term survival prediction.

We herein report a case of a gastric schwannoma with elevated preoperative serum carbohydrate antigen 19-9 (CA19-9) (155.2 U/ml, normal range 0-36.9 U/ml). A 59-year-old Japanese man was admitted to our hospital for treatment of a submucosal tumor of the stomach detected by barium meal, upper gastrointestinal endoscopy, and computed tomography. Endoscopic examination revealed a 3-cm diameter submucosal tumor in the antrum of the stomach, but biopsy of the lesion was unable to confirm the diagnosis. Positron emission tomography to evaluate the malignant potential showed a high uptake of (18)F-fluorodeoxyglucose in the tumor. Laparoscopy-assisted distal gastrectomy was therefore performed. The histopathological findings of the surgical specimen revealed a benign gastric schwannoma, positive for S-100 protein. The postoperative serum CA19-9 levels gradually decreased and normalized. To the best of our knowledge, this is the first report of a gastric schwannoma with elevated serum CA19-9.

Primary squamous cell carcinoma (SCC) of the stomach is an extremely rare tumor and its pathogenesis is still unknown. We report a case of SCC of the stomach in a 69-year-old man. The patient's stomach contained an area of SCC surrounded by squamous metaplasia. To our knowledge, this is the first reported study to have investigated the pathogenesis of this tumor type by immunohistochemistry, liquid hybridization assay for human papilloma virus (HPV) infection, and polymerase chain reaction for Epstein-Barr virus (EBV) infection. These tests yielded proof of EBV infection in surgical specimens of the tumor. Therefore, we suggest that EBV infection may be involved in the pathogenesis of SCC arising in the stomach.