Gastric adenosquamous carcinoma(ASC)is a rare type of gastric cancer.It is a mixed neoplasm,consisting of glandular cells and squamous cells.It is often diagnosed at an advanced stage,thus carrying a poor prognosis.We describe a case of a 73-year-old male,who presented with refractory fever and an intra-abdominal mass on imaging.He underwent a laparoscopic exploration followed by a successful totally laparoscopic total gastrectomy with D2 lymphadenectomy for gastric cancer.Postoperative pathology revealed primary gastric ASC(T4aN0M0).The patient received adjuvant radiotherapy and chemotherapy with S1 and is alive 20mo after surgery without recurrence.This is the first case of advanced gastric ASC with fever as the initial presentation treated with totally laparoscopic total gastrectomy reported in the English literature. Gastric adenosquamous carcinoma (ASC) is a rare type of gastric cancer. It is often a mixed neoplasm, consisting of glandular cells and squamous cells. It is often diagnosed at an advanced stage, thus carrying a poor prognosis. We describe a case of a 73 -year-old male, who presented with refractory fever and an intra-abdominal mass on imaging. He underwent a laparoscopic exploration followed by a successful totally laparoscopic total gastrectomy with D2 lymphadenectomy for gastric cancer. Postoperative pathology revealed primary gastric ASC (T4a NOM0). The patient received adjuvant radiotherapy and chemotherapy with S1 and is alive 20mo after surgery without recurrence. This is the first case of advanced gastric ASC with fever as the initial presentation treated with totally laparoscopic total gastrectomy reported in the English literature.