PMC4000302_01
a, b An endoscopic examination revealed an ulcerated protruding tumor that occupied the lesser curvature of the upper to lower gastric body. This tumor was diagnosed as advanced type 3 gastric cancer.
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F1
Upper gastrointestinal endoscopy revealed type 3 advanced gastric cancer of the lesser curvature of the upper to lower gastric body (fig. 1a, b), and histological analysis of biopsy samples showed poorly-differentiated adenocarcinoma.
a, b The pathological diagnosis of the resected specimens was adenosquamous cell carcinoma with a mixture of both adenocarcinoma (a) and squamous cell carcinoma components (b). c, d Immunohistochemical analysis showed strong positivity for HER2 (HerceptestTM) in both components. e, f Dual-color chromogenic in situ hybridization revealed high amplification of the HER2 gene (INFORM HER2 Dual ISH; red, chromosome 17 centromere; black, HER2) in both components.
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F2
A pathological diagnosis of the resected ASC specimens showed that it was composed of a mixture of adenocarcinoma and squamous cell carcinoma components (fig. 2a, b). A/S, Glostrup, Denmark) showed that both the squamous carcinoma and adenocarcinoma components of the primary tumor were strongly positive (score, 3+) for HER2 (fig. 2c, d). A high level of HER2 gene amplification in both components was also detected by dual-color chromogenic in situ hybridization (INFORM HER2 Dual ISH; Ventana Medical Systems Inc., Oro Valley, Ariz., USA) (fig. 2e, f).
a An abdominal CT scan revealed multiple liver metastases. b After 3 cycles of chemotherapy with capecitabine, cisplatin, and trastuzumab, a PR was observed. c After 6 treatment cycles, a PR was confirmed with no evidence of new lesions. d Thirteen months after initial chemotherapy, a PET-CT scan showed no increase in the metastatic hepatic lesions.
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F3
About 2.5 months after curative surgery, an abdominal CT scan showed multiple metastatic lesions in the bilateral lobes of the liver (fig. 3a). After 3 treatment cycles, all metastatic liver lesions had regressed (fig. 3b) and a partial response (PR) was confirmed after 6 cycles (fig. 3c). PET and CT scans performed 13 months after chemotherapy initiation revealed no uptake in the metastatic liver lesions (fig. 3d).