PMC4752374_01
Coronal oblique 5 mm MIP reconstruction CT image from Patient 1 before treatment.. This image shows asymmetric, diffuse thickening of the inferior wall of gastric body and antrum with infiltration of adjacent fat as well as extensive mesenteric lymphadenopathy.
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FIG1
CT scan on July 1, 2015 (Figures 1-2) showed asymmetric, diffuse thickening of the inferior wall of the gastric body and antrum with infiltration of adjacent fat, a peritoneal nodule, and extensive mesenteric lymphadenopathy.
Transverse CT image taken from Patient 1 before treatment.. This image shows a left supraclavicular adenopathy measuring 1.4 x 2.0 cm.
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FIG2
CT scan on July 1, 2015 (Figures 1-2) showed asymmetric, diffuse thickening of the inferior wall of the gastric body and antrum with infiltration of adjacent fat, a peritoneal nodule, and extensive mesenteric lymphadenopathy.
Coronal oblique 5 mm MIP reconstruction CT image taken from Patient 1 after four cycles of FOLFOX.. This image shows significant interval decrease in disease burden with a marked decrease in the size of the primary gastric mass in addition to a complete resolution of the previously documented infiltration of adjacent fat and extensive mesenteric lymphadenopathy.
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FIG3
Following four cycles of FOLFOX, the patient underwent a restaging CT (Figures 3-4).
Transverse CT image taken from Patient 1 after four cycles of FOLFOX.. This image shows that the left supraclavicular node decreased in size to 0.8 x 0.6 cm from 1.4 x 2.0 cm.
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FIG4
Following four cycles of FOLFOX, the patient underwent a restaging CT (Figures 3-4).
Representative microscopic images of the gastric tumor taken from Patient 1 at a magnification of 20x.. A) ERCC1 IHC staining read as intensity 2+ (on a scale of 0-3. 0: no staining; 1+: faint staining; 2+: weak to moderate staining; 3+: strong staining) on 65% of tumor cells. B) Haematoxylin and eosin staining showing poorly differentiated adenocarcinoma.
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FIG5
The patient's outstanding response prompted us to perform a posthoc tumor profiling analysis to look for underlying molecular aberrations, the knowledge of which may provide insight into the identification of potential responders in the future (Figure 5).
PMC4752374_02
Image from esophagogastroduodenoscopy (EDG) performed on Patient 2 before she received therapy.. This image shows a tight, friable, fungating, malignant-appearing mass circumferentially involving the gastric cardia and gastroesophageal valve.
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FIG6
Subsequently, an endoscopy was performed revealing a large mass at the gastric cardia (Figure 6).
Contrast-enhanced CT image of the abdomen from Patient 2 prior to treatment.. This image reveals asymmetric wall thickening of gastric cardia, measuring approximately 2.7 x 4 cm, with stranding into adjacent fat.
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FIG7
Gastrohepatic ligament lymphadenopathy, measuring 1.8 x 1.3 cm, was also observed, along with about five subcentimeter indeterminate liver lesions (Figure 7) .
Image from EDG performed on Patient 2 after six cycles of EOX and four months of capecitabine monotherapy. . This image shows normal-appearing gastric cardia without endoscopic evidence of disease.
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FIG8
Follow-up esophagogastroduodenoscopy (EGD) showed normal gastric cardia with no endoscopic evidence of disease (Figure 8).
Contrast-enhanced CT image of the abdomen from Patient 2 after continued treatment with capecitabine monotherapy.. This image shows continued absence of disease, with no appreciable mass in the gastric cardia.
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FIG9
At the patient's last visit in November 2015, she showed no evidence of disease by CT scan, with the exception of a stable, subcentimeter, gastrohepatic ligament lymph node (Figure 9).