PMC5828287_01
A - Gastroesophageal transit showing a huge mass involving the esophagogastric junction and the gastric fundus; B - CT scan showing an exophytic mass in the lesser gastric curvature referring to the known gastric cancer (asterisk).
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A gastroesophageal transit and an upper abdominal endoscopy were performed; an important ulcerated tumor was seen, which involved the esophagogastric junction and the gastric fundus with active bleeding (Figure 1A). A computed tomography (CT) scan (Figure 1B) was also performed and revealed extensive gastric wall thickening extending from the cardia through the minor curvature.
Photomicrography of the gastric biopsy. A - Nests of a poorly differentiated carcinoma stained with hematoxylin-eosin; B - Diffuse cytoplasmic synaptophysin immunostaining; C - High cell proliferation index, showing 90% of Ki-67 positive cells.
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(Figure 2).
A and B - CT-scans revealing a major tumoral response, with almost complete recovery of the gastric wall (black arrow), but a lymph node of 20 mm remained in the celiac axis (white arrow).
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A - CT scan showing local relapse (asterisk); B - The sustained major tumoral response after the 44th cycle of chemotherapy (arrow).
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The patient has been free of tumor progression for 24 months, on the 44th cycle of the De Gramont scheme and the last CT scan (Figure 4B) documented a sustained major tumoral response.