A 69-year-old man with chronic
gastritis,
reflux esophagitis, esophageal
hiatal hernia, and history of
appendicitis surgery complained of difficulty swallowing. Upper gastrointestinal endoscopy revealed
a 10 cm sized Type 3
gastric cancer. Immunostaining was positive for
chromogranin A(2+),
synaptophysin(3+), CD56(-), and Ki-67>70%. Contrast computed tomography(CT)showed upper gastric wall thickening, and #1, #3, #7, #8a, and #11p enlarged lymph nodes but no distant
metastasis. We diagnosed
gastric cancer, UM, Less, Type 3, gastric
neuroendocrine carcinoma, cT4aN3M0P0CY0, Stage ⅢC. We administered 2 courses of CDDP plus
CPT-11 chemotherapy, and a partial response was obtained for the primary gastric lesion and
lymph node metastases. We subsequently performed open distal
gastrectomy, D2
lymph node dissection, and
splenectomy. Pathological examination confirmed that the lesion was
gastric cancer, U, Less, Type 3, gastric
neuroendocrine carcinoma, MP, Ul-Ⅱ(+), int, INF b, ly2, v0, PM0, DM0, R0, ypT2N2, Stage ⅡB, with a therapeutic value of Grade 2. The patient was discharged on day 15 after the surgery and received 2 courses of
adjuvant chemotherapy with CDDP plus
CPT-11. Nine months after the surgery,
metastasis of the left adrenal grand was found. We performed open left adrenal gland resection and administered adjuvant S-1
chemotherapy.