J Gastric Cancer.  2016 Jun;16(2):115-119. 10.5230/jgc.2016.16.2.115.

A Case of Long-Term Complete Remission of Advanced Gastric Adenocarcinoma with Liver Metastasis

• Rim C
• Lee JA
• Gong S
• Kang DW
• Yang H
• Han HY
• Kim NY

• KMID: 2328079
• DOI: http://doi.org/10.5230/jgc.2016.16.2.115

Abstract

We report the case of a patient with gastric adenocarcinoma with multiple liver metastases. This patient showed complete remission for more than 68 months after S-1/cisplatin combination chemotherapy and radical total gastrectomy. The patient, a 63-year-old man, presented with dyspepsia and difficulty in swallowing. Endoscopic findings showed a huge ulcero-infiltrative mass at the lesser curvature of the mid-body, extending to the distal esophagus. Biopsy revealed a poorly differentiated tubular adenocarcinoma. An abdominal computed tomography scan demonstrated multiple hepatic metastases. S-1/cisplatin combination chemotherapy was initiated, and following completion of six cycles of chemotherapy, the gastric masses and hepatic metastatic lesions had disappeared on abdominal computed tomography. Radical total gastrectomy and D2 lymphadenectomy combined with splenectomy were performed. The patient underwent three cycles of S-1/cisplatin combination chemotherapy followed by tegafur-uracil therapy for 1 year. He remained in complete remission for more than 68 months after surgery.

Keyword

Gastric cancer; Liver metastasis; Gastrectomy, S-1, Cisplatin; Cisplatin

MeSH Terms

Adenocarcinoma*
Biopsy
Cisplatin
Deglutition
Drug Therapy
Drug Therapy, Combination
Dyspepsia
Esophagus
Gastrectomy
Humans
Liver*
Lymph Node Excision
Middle Aged
Neoplasm Metastasis*
Splenectomy
Stomach Neoplasms
Cisplatin

Figure

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  Fig. 1 Initial (A, B) and follow-up (C, D) endoscopic findings after six cycles of S-1/cisplatin combination chemotherapy: (A) An ulcero-infiltrative mass at the lesser curvature of the mid-body. (B) An ulcero-fungating mass extending to the distal esophagus. (C) Disappearance of the gastric cardia mass, and erosive lesions at the site of the previous mass. (D) Ulcer scar without a definite mass-like lesion.

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  Fig. 2 Microscopic findings at the time of diagnosis. Poorly differentiated tubular adenocarcinoma (A: H&E, ×100; B: H&E, ×400).

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  Fig. 3 Initial abdominal computed tomography scan (A~C) and follow-up scan after three cycles of S-1/cisplatin combination chemotherapy (D~F): (A) Irregular wall thickening on the lesser curvature side of the gastric upper body with perigastric fat invasion, multiple metastases to neighboring lymph nodes, and metastatic lesion in liver segment 6. (B) Multiple hepatic metastatic lesions and small low attenuating nodules with rim enhancement in liver segment 3. (C) Hypodense hepatic metastatic lesion in liver segment 3. (D) Scan shows that the metastatic lesion in liver segment 6 decreased in size from 1.2 cm to less than 1.0 cm. (E) Disappearance of hepatic metastatic nodules that had been previously observed. (F) Scan shows that the metastatic lesion in liver segment 3 decreased in size from about 1.1 cm to less than 1.0 cm.

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  Fig. 4 Follow-up abdominal computed tomography scans after six cycles of S-1/cisplatin combination chemotherapy (A, B) and 68 months after surgery (C, D): (A) Scan shows that the gastric mass and neighboring lymph nodes have almost disappeared. (B) Scan shows that the hepatic metastatic nodules that had been previously observed have disappeared (C). Radical total gastrectomy with Rouxen-Y esophagojejunostomy combined with splenectomy was performed. Scan shows that there was no evidence of tumor recurrence 68 months after surgery. (D) There was no recurrence of the hepatic metastatic lesions and the patient maintained complete remission for 68 months.

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