PMC8798783_01
Preoperative examination results. (A) The endoscopic examination of primary tumor in stomach before surgery; (B) the ultrasonography examination of primary tumor in stomach before surgery; (C) the pathological result of primary tumor in stomach before surgery (HE, SP x100).
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Endoscopic ultrasonography revealed an ulcer-type tumor, with maximum diameter of 4.0 cm, involving more than two-thirds of the stomach wall between the antrum and the body of the stomach (Figure 1A,B). Histopathological examination of biopsy specimen by two pathologists confirmed poorly differentiated adenocarcinoma (Figure 1C).
The abdominal enhanced CT scanning showed the significantly diffused thickness of stomach wall with multiple enlarged and coalesced perigastric and extragastric lymph nodes (Bulky lymph nodes labeled by the red arrow). CT, computed tomography.
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Abdominal enhanced CT showed diffuse thickening of the stomach wall and multiple enlarged and coalesced perigastric and extragastric lymph nodes (Figure 2).
The abdominal enhanced CT scanning demonstrated that partial remission of the stomach wall thickness and the perigastric and extragastric lymph nodes after two cycles of SOX regimens chemotherapy plus apatinib. CT, computed tomography; SOX, S-1 and oxaliplatin.
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Repeat enhanced CT after drug therapy showed partial remission of the stomach wall thickness, and decrease in the maximum diameter of all perigastric and extragastric lymph nodes to <1.0 cm (Figure 3).
Intraoperative diagnosis. (A) The laparoscopic detection of the abdominopelvic cavity of patient; (B) the result of the peritoneal lavage cytology of patient (SP x100, HE staining).
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Four weeks later, after peritoneal dissemination was ruled out by laparoscopy (Figure 4A) and peritoneal lavage cytology (Figure 4B), radical distal subtotal gastrectomy plus D2 lymphadenectomy with para-aortic lymph node dissection was performed (Figure 5).
Intraoperative operation image. (A) Dissection of the segment of transverse mesocolon invaded by the primary tumor; (B) distal subtotal gastrectomy was performed; (C) D2 lymphadenectomy was accomplished in the procedure of curative gastrectomy for this patient; (D) the para-aortic lymph node dissection was performed for this patient.
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Four weeks later, after peritoneal dissemination was ruled out by laparoscopy (Figure 4A) and peritoneal lavage cytology (Figure 4B), radical distal subtotal gastrectomy plus D2 lymphadenectomy with para-aortic lymph node dissection was performed (Figure 5).
The postoperative histopathological result of the patient. (A,B,C) HE staining; (D,E,F) IHC staining.
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Expression of cancer molecular biomarkers on immunohistochemical staining was as follows: CK8/18 (+), CK7 (+), Ki-67 (80%), and HER-2 (-) (Figure 6).
Postoperative follow-up examination results. (A) The endoscopic examination showed no evidence of recurrence in remnant stomach or in anastomosis; (B) the abdominal enhanced CT scanning showed no evidence of recurrence and distant metastasis. CT, computed tomography.
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No local recurrence or distant metastasis has been detected even 2 years after surgery (Figure 7), and serum tumor markers remain within normal limits (CA72-4 1.15 U/mL, CA19-9 2.38 U/mL, CA125 3.88 U/mL).
Case report timeline. SOX, S-1 and oxaliplatin; MDT, multidisciplinary team.
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The timeline of case report is clearly shown in Figure 8.