PMC10091231_01
Gross pathology of the resected stomach with green arrows indicating the tumor of 5.5 cm (a), the hematoxylin and eosin (H&E) stain of the original GC at x200 magnification (b), and the immunohistochemical HER2 status of this specimen showing 0 out of 3 at x200 magnification (c).
cro530109_f01.jpg
PMC10091231_01_cro530109_f01.jpg
F1
The resection gross pathophysiology is shown in Figure 1a, the hematoxylin and eosin stain in Figure 1b, and HER2 immunohistochemistry in Figure 1c.
a Computed tomography image of the brain showing a brain tumor of 35 mm. b A positron emission tomography image of the whole body shows no other tumor other than in the brain. c The biopsy of the brain was stained with H&E, demonstrating tubule-papillary structures lined by tumor cells within necrotic background at x200 magnification. d Immunohistochemical staining for cytokeratin 7 is positive in tumor cells at x200 magnification. e After 8 years, a follow-up brain CT computed tomography scan showed no tumor recurrence. H&E, hematoxylin and eosin.
cro530109_f02.jpg
PMC10091231_01_cro530109_f02.jpg
F2
The resection gross pathophysiology is shown in Figure 1a, the hematoxylin and eosin stain in Figure 1b, and HER2 immunohistochemistry in Figure 1c. Thus, brain computed tomography was performed, showing a brain mass of 3.5 cm in the right temporal region (Fig. 2a). To further evaluate metastasis to other organs, we performed positron emission tomography which showed no metastases other than those in the brain (Fig. 2b). However, the brain tumor specimen was found to be metastatic adenocarcinoma originating from GC (hematoxylin and eosin stain in Fig. 2c) as it was positive for cytokeratin 7 (Fig. 2d) and negative for caudal type homeobox 2, cytokeratin 20, prostate-specific antigen, and thyroid transcription factor 1. The patient had no metastasis to any other organs 8 years after the completion of chemotherapy (Fig. 2e).
Timeline of the treatment. The patient was diagnosed with gastric cancer (GC) in April 2013 by esophagogastroduodenoscopy. He underwent total gastrectomy surgery and 6 months of adjuvant chemotherapy of tegafur/gimetacil/oteracil with cisplatin. Two years later, he had a solitary brain mass, which was confirmed as a GC brain metastasis (BM) by a surgical resection in October 2015. Afterward, he had 12 cycles of chemotherapy (FOLFOX) treatment. Eight years after his chemotherapy treatment, he is still in remission.
cro530109_f03.jpg
PMC10091231_01_cro530109_f03.jpg
F3
The treatment timeline is shown in Figure 3.