A 72-year-old woman was referred to our hospital for further examination of para-aortic lymph node swelling and elevated
carbohydrate antigen 19-9 levels. Thirteen years ago, she had undergone distal
gastrectomy for
gastric cancer, and the final diagnosis was T4N1M0, Stage ⅢA. Abdominal contrast-enhanced computed tomography(CT)showed an enlarged para-aortic lymph node measuring 25 mm. Endoscopic ultrasound-guided fine-needle aspiration was performed, and biopsy specimens showed poorly differentiated
adenocarcinoma. Under the clinical diagnosis of
gastric cancer recurrence, the patient received
chemotherapy with
cisplatin plus S-1. After 5 cycles of systemic treatment, abdominal CT revealed a marked shrinkage of the para-aortic
lymph node metastasis, with an 84% decrease. At 15 months
after treatment, we switched to S-1 monotherapy because of general
fatigue and the patient's preference. However, 22 months after the treatment, the patient was treated with
ramucirumab due to the progression of para-aortic
lymph node metastasis. After 33 months, the patient developed
metastasis in the left ovary, measuring 11.0×8.5 cm. Because there was no evidence of further metastatic lesions in any other organs, she underwent left
oophorectomy. After 37 months, the patient developed
metastasis in the left cerebellum, measuring 3.2×2.5 cm, accompanied with
headache and
nausea. The patient underwent
metastasectomy of the left cerebellum as
palliative treatment. Simultaneous physical examination revealed a painful nodular elevated lesion in the subcutaneous tissue of the posterior neck region, measuring 18×15 cm. Pathological examination of the biopsy specimen showed infiltration of poorly differentiated
adenocarcinoma cells into the subcutaneous mass. The patient received
radiation therapy; however, she died due to
septic shock with
hydronephrosis 39 months after starting
chemotherapy. Although late recurrence of
gastric cancer is rare, identification of risk factors and the development of novel treatments should be achieved through further studies and accumulation of data from such cases.