PMC9641636_01
Abdominal enhancement CT showed obvious enhancement of the edge of the tumor in the arterial phase (A); Abdominal enhanced CT showed enlarged retroperitoneal lymph nodes (B); 18F-FDG PET-CT showed that the left axillary lymph node was enlarged, and the mass uptake of FDG increased slightly, but it was considered as an inflammatory lesion (C).
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The abdominal enhanced CT shows multiple lymph nodes enlargement in the abdominal and retroperitoneum in the outpatient clinic of our hospital ( Figures 1A, B  ). After the end of neoadjuvant chemotherapy, we performed a PET-CT examination for the patient. 18F-FDG PET-CT showed that the mass showed changes after chemotherapy, slight thickening of the lesser curvature of the stomach, the mass did not significantly absorb FDG, and it was found that the left axillary lymph node was enlarged, and the mass uptake of FDG increased slightly, but it was considered as an inflammatory lesion ( Figures 1C ).
Pathological picture after radical total gastrectomy (A); Pathological picture after radical axillary lymph nodes (B); Immunohistochemical staining showed axillary lymph node tumor cells express CDX2 (C); Immunohistochemical staining showed axillary lymph node tumor cells express CK20 (D); Immunohistochemical staining showed some axillary lymph node tumor cells express SATB-2 (E).
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Lauren's classification was the diffuse type ( Figure 2A ). Pathology showed that the tumor cells were poorly differentiated adenocarcinoma. immunohistochemical staining showed that most of the tumor cells expressed Caudal-type homeobox 2 (CDX2), CK20, GATA binding protein 3 (GATA-3), and a small amount of sequence-binding protein (SATB) 2 and Mucin-5AC (MUC5AC), but no expression of CK7 and TTF-1 was found ( Figures 2B-E ).
Axillary ultrasound showed enlarged axillary lymph nodes (A); The mammary gland molybdenum target X-ray was not found obvious breast mass (B, C); No obvious mass was found in whole-body bone scintigraphy (D).
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Ultrasound examination of the bilateral breast and axilla showed that there was no obvious mass in the bilateral breast, and several hypoechoic lesions were found in the left axilla, the size of which was about 4.3 x 1.9cm, the boundary was clear, the cortex was thickened, the medulla was eccentric and the blood flow signal was abundant ( Figure 3A ). No obvious abnormality was found in mammary gland molybdenum target X-ray ( Figures 3B, C  ), mediastinal and supraclavicular enlarged lymph nodes were not found in CT, and no obvious bone metastasis in whole-body bone scintigraphy ( Figure 3D ).
CEA, CA19-9, and CA72-4 increased gradually after radical axillary lymphadenectomy.
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The patient received docetaxel and fluorouracil chemotherapy after radical axillary lymph node dissection, and a progressive increase in CEA, CA19-9, and CA72-4 was found (  Figure 4  ).