PMC6218800_01
Initial (a) and follow-up (b) endoscopic findings after six cycles of EOX chemotherapy. (a) A large ulceroinfiltrative mass at the anterior wall of the lesser antral curvature, covered with whitish fur, and no apparent active bleeding; (b) ulcer lesion disappeared and replaced by scar.
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Upper gastrointestinal endoscopic findings showed 3 cm x 2 cm ulcers at the anterior wall of the lesser antral curvature with no apparent active bleeding (Figures 1(a) and 1(b)). Follow-up endoscopy showed that the ulcer lesion had disappeared and was replaced by scar tissue (Figure 1(b)).
Microscopic findings at the time of diagnosis. Well differentiated tubular adenocarcinoma ((a) H&E, x100; (b) H&E, x200).
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Histopathological examination revealed a well differentiated tubular adenocarcinoma (Figure 2).
Initial abdominal computed tomography scan (a~c) and follow-up scan after three cycles of EOX chemotherapy (d~f). (a, b, and c) Irregular wall thickening on the lesser curvature side of the gastric antrum with mass formation, large ulceroinfiltrative, and multiple metastases to neighboring lymph nodes; (d, e) scan shows that the mass of the gastric antrum decreased in range from approximately 7 cm to less than 3.3 cm; (f) disappearance of metastatic lesion of neighboring lymph nodes that had been previously observed.
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An abdominal computed tomography (CT) scan demonstrated irregular wall thickening on the lesser curvature side of the gastric antrum with mass formation with a large ulceroinfiltration as well as multiple metastases to neighboring lymph nodes (Figures 3(a)-3(c)). In October 2015, after completion of three cycles of chemotherapy, an abdominal CT scan showed that the mass of the gastric antrum had decreased to less than 3.3 cm (Figures 3(d) and 3(e)), and metastatic lesions of neighboring lymph nodes that had been previously observed had disappeared (Figure 3(f)).
Initial abdominal computed tomography scan (a, b) and follow-up scan after three cycles of EOX chemotherapy (c, d). (a) Scan shows that the metastatic lesion in liver segment 4; (b) hypodense metastatic lesions in the left lobe of liver; (c) scan shows that the metastatic lesion in liver segment 4 has decreased in size from 2.8 cm to less than 0.9 cm; (d) scan shows that the metastatic lesion in the left lobe of liver has decreased in size from 4.3 cm to less than 1.5 cm.
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The CT scan also revealed metastatic lesions in liver segment 4 (Figure 4(a)) and evidence of hypodense liver metastatic lesions in the left lobe of the liver (Figure 4(b)). The CT scan also showed multiple liver metastases lesions that ranged in size from 1.0 to 4.3 cm over the entire liver (Figures 4(a) and 4(b)). The scan showed that the liver metastatic lesions had almost disappeared, with the exception of lesions in the left lobe of the liver, which measured less than 1.5 cm in size (Figures 4(c) and 4(d)).
Follow-up abdominal computed tomography scans after six of EOX chemotherapy (a, b, c) and 27 months after surgery (d, e). (a) The liver metastatic nodules in liver segment 4 that had been previously observed have almost disappeared; (b) the liver metastatic lesion in the left lobe of liver that had been previously observed has evidently been reduced; (c) the gastric mass has almost disappeared; (d) postradical distal gastrectomy with Roux-en-Y with residual stomach and jejunum anastomosis and D2 lymphadenectomy combined with liver metastatic lesions resection, with no evidence of tumor recurrence 27 months after surgery; (e) no recurrence of metastatic lesions after 27 months.
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This result showed that the liver metastatic nodules that had been previously observed were no longer present (Figures 5(a) and 5(b)). The scan showed that the gastric mass had almost disappeared (Figure 5(c)). The patient had maintained CR for more than 27 months after surgery, with a 33-month overall survival (Figures 5(d) and 5(e)).