Case Of Gastric Adenocarcinoma Research Articles

Gastric Cancer Showing Rapid Recurrence and Progression: A Case of Gastric Adenocarcinoma With Enteroblastic Differentiation

Gastric adenocarcinoma with enteroblastic differentiation (GAED) is rare and its clinicopathological characteristics are not well documented. However, reports indicate that it exhibits more aggressive characteristics, including lymph node metastasis or liver metastasis, than a conventional gastric adenocarcinoma. Herein, we report a case of GAED with rapid recurrence and disease progression. A 55-year-old male, diagnosed with gastric cancer (GC), demonstrated initial endoscopic findings suggestive of advanced GC. He underwent curative resection since there was no evidence of lymph node or distant metastases. The disease was reported as an early GC that was confined to the submucosal layer, without evidence of lymph node metastasis in the final pathological results. However, six months after surgery, multiple hepatic metastases were found during abdominal computed tomography; the pathological results were consistent with metastasis from the GC. Immunohistochemistry of the primary carcinoma pathological specimens showed positive results for alpha-fetoprotein and sal-like protein 4, suggesting enteroblastic differentiation, which is thought to be associated with rapid recurrence and disease progression.

Gastric collision tumor with diffuse large B-cell lymphoma and adenocarcinoma: A rare case report and literature review.

Gastric adenocarcinoma is a common malignant tumor of the digestive system. Primary diffuse large B-cell lymphoma (DLBCL) of the stomach is a common lymphoma originating from gastric submucosal lymphoid tissue, and the coexistence of DLBCL and adenocarcinoma is exceedingly rare. A 58-year-old woman came to our hospital for treatment because of a choking feeling after eating. During endoscopy, it was confirmed that multiple irregular ulcers were seen in the fundus and body of the stomach, and the surrounding mucosa was raised. The biopsy pathology showed poorly differentiated cancer, and the patient did not undergo immunohistochemical detection. A distal gastrectomy was performed. Pathological evaluation of resected specimens is as follows: gastric tubular adenocarcinoma and germinal center-type (GC)-DLBCL. No migration was found at the junction of the two tumors, forming a collision tumor. The patient received two cycles of Rituximab - Cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) chemotherapy, and there is no recurrence at present. We report a case of primary gastric adenocarcinoma colliding with the GC-DLBCL. Clinicians and pathologists should pay attention to it to avoid missed diagnosis.

Gastric adenocarcinoma in Situs inversus totalis: a case study and literature review.

Situs inversus totalis (SIT) is an uncommon disorder characterized by mirror-image anatomy, which can present unique challenges and potential vascular anomalies in surgical interventions, particularly in gastric cancer patients. We aim to delineate a rare case of gastric adenocarcinoma in a SIT patient and conduct a thorough review of the existing literature concerning surgical strategies, vascular anomalies, and outcomes observed across varied geographic locales and technological approaches. A thorough examination of a case involving a 39-year-old male SIT patient who underwent a successful distal gastrectomy with D2 lymph node dissection is presented alongside an expansive literature review. The review encompasses 47 articles, collating data on surgical approaches and vascular anomalies across 49 patients diagnosed with SIT and gastric cancer. The patient underwent curative distal gastrectomy and Billroth II with Braun anastomosis within 95 minutes, incurring minimal intraoperative blood loss (100ml). Postoperative pathology confirmed moderately to poorly differentiated gastric adenocarcinoma (pT3N0M0), with no signs of recurrence or metastasis after 6 months of S-1 adjuvant chemotherapy. The literature review revealed vascular anomalies in approximately 20% of reported cases, accentuating its surgical significance. Noteworthy variations in surgical strategies, operative times, blood loss, and complications across different surgical modalities were observed, providing a comprehensive view into the practical management of such cases. Despite the inherent challenges associated with SIT, various surgical techniques can be successfully applied with meticulous preoperative planning and understanding vascular anomalies. This compilation of diverse surgical experiences across numerous documented cases seeks to provide a consolidated resource for refining surgical strategies and enhancing postoperative outcomes for gastric cancer patients with SIT, underscoring the imperativeness of further research in this niche domain.

ASSOCIATION OF HER2/NEU EXPRESSION WITH PATIENT PROGNOSIS IN PRIMARY GASTRIC ADENOCARCINOMA

Introduction: Gastric carcinoma is the second leading cause of cancer related deaths in the world. Aim of the present study was to determine the association of HER2 overexpression with prognostic factors in gastric adenocarcinoma affected Pakistani patients.
 Methods: For this purpose, immunohistochemical staining of gastric cancer patients (n=200) was performed. HER2 was found to be overexpressed in 70% of cases included in the study. Association of HER2 expression with age greater than 40 years at the time of diagnosis, histological types and moderately differentiated grades of primary gastric adenocarcinoma was observed.
 Results: HER2 was found to be overexpressed in 20% of cases. No association of HER2 was identified with the gender of the patients. Interestingly, HER2, overexpression was present in 75% of intestinal and 37% of diffuse type gastric adenocarcinoma. Based on tumor differentiation, well-differentiated (grade I) and moderately differentiated type (grade II) adenocarcinoma showed overexpression of HER2 in 90 and 80% patients respectively. Moreover, 60% patients having poorly differentiated adenocarcinoma (grade III) also exhibited HER2 overexpression.
 Conclusion: Due to presence of HER2 overexpression in diffuse type gastric carcinoma as well, it is suggested that every case of gastric adenocarcinoma should be tested for HER2 overexpression so that they can be offered targeted molecular therapy for better survival.

The role of surgery in the management of liver metastases from non-colorectal cancers: A review of the literature

Surgery for non-colorectal liver metastases is nowadays indicated due to advances in surgical techniques and patients multimodal management. The objective of our study is to evaluate the surgical management of liver metastases of non-colorectal cancers in the visceral surgery department of the Mohamed V military hospital in Rabat. This is a retrospective study on a series of 13 resections for non-colorectal liver metastases over a period of 6 years from January 2015 to December 2020. In our series, the average age is 53 years with a prevalence of women (62%). The primary cancer was ducal breast carcinoma 6 times (46.15%). There were 2 cases of stromal tumors (15.38%), 2 cases of neuroendocrine tumors (15.38%), one case of gastric adenocarcinoma, gastric small cell lymphoma, and of adrenocortical carcinoma. Liver metastases were synchronous in 76.92% of cases, metachronous in 23.08% of cases. They were unique in 84.62% of cases, bilobar in 15.38% of cases. The type of liver resection performed was 11 metastasectomy, 3 segmentectomy, 3 bi-segmentectomy. Mortality rate was zero and the morbidity rate was 15.38%. One patient had hepatic recurrence. With a follow-up of 3 to 36 months after resection, only one patient died after 12 months. The management of patients with non-colorectal liver metastases is based on a multimodal approach. Our results show that surgery, when feasible in selected patients, is a safe option and the only possibility for long-term survival. Future advances in chemotherapy, biotherapies and immunotherapy are likely to broaden the indications for surgery.

Early Detection of Gastric Intramucosal Adenocarcinoma on 68Ga-FAPI PET/CT.

18F-FDG PET/CT may sometimes not be an ideal imaging method for gastric adenocarcinoma. Because of the unstable physiological uptake of 18F-FDG in the gastrointestinal tract and muscles, it may interfere with the detection of lesions. We present a case of gastric intramucosal adenocarcinoma detected by 68Ga-FAPI PET/CT in a patient with nasopharyngeal carcinoma.

A case of gastric mucinous adenocarcinoma with special morphology

胃黏液腺癌是一种少见的胃癌组织学类型，其大体分型多为隆起型，内镜发现时多已是进展期，且病变的活检病理诊断稍困难。本例进展期胃黏液腺癌的内镜下表现形态极为特殊，呈蜂窝空洞样，明显不同于常见进展期胃癌形态，而且病理提示为单纯的黏液腺癌，未见中高分化胃癌及其他未分化癌组织细胞成分，同时多次、多部位活检后仍难以明确病理性质。此类病例鲜有文献报道。.

Gastric Adenocarcinoma of the Remnant Stomach After Roux-en-Y Diagnosed by Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE)

It can be difficult to evaluate for pathology with traditional endoscopic modalities following a Roux-en-Y gastric bypass. This is due to the truncated gastrointestinal tract and excluded distal stomach formed during a Roux-en-Y procedure. In these circumstances, a modified endoscopic procedure, known as endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) is used. Although the Roux-en-Y procedure slightly increases the risk of gastric adenocarcinoma in the general population, the occurrence of gastric adenocarcinoma in the excluded stomach, specifically, is uncommon. Herein, we present a case of gastric adenocarcinoma of the excluded stomach, diagnosed 20 years after a Roux-en-Y procedure. This case is unique because after an extensive five-year workup for melena and iron deficiency anemia, the malignancy was ultimately diagnosed utilizing the innovative EDGE procedure.

A Case of Gastric Adenocarcinoma With Pernicious Anemia, Polyneuropathy, and Subacute Combined Degeneration Caused by Autoimmune Gastritis.

A Case of Gastric Adenocarcinoma With Pernicious Anemia, Polyneuropathy, and Subacute Combined Degeneration Caused by Autoimmune Gastritis.

S2576 Application of Hemospray for Metastatic Bleeding Gastric Adenocarcinoma: A Case Report

Introduction: TC-325 hemostatic powder (Hemospray) is a mineral-based topical agent that acts as a mechanical barrier over a bleeding site. It is a non-invasive, safe, and effective modality in controlling active GI bleeding, with immediate response. Here, we present a case of bleeding metastatic gastric adenocarcinoma managed with Hemospray after the failure of standard endoscopic therapy. Case Description/Methods: A 64-year-old male presented to the emergency room (ER) for symptomatic anemia. His hemoglobin was 4.6 g/dL. CT imaging showed gastric cardia lesion with multiple hepatic metastases. After blood transfusion, EGD (Figure 1a) showed a cardia lesion with oozing blood from multiple sites. Endoscopic ultrasound with fine-needle aspiration, showing atypical cells. The patient continued to have melena requiring transfusions. CT angiogram was negative. Partial gastrectomy was not performed due to peritoneal carcinomatosis. Endoscopic hemostasis with epinephrine and clips failed (Figure 1b). Hemospray was deployed (Figure 1c) with an immediate response. Later patient underwent left gastric artery embolization (Figure 1d), liver biopsy and peritoneal node sampling that suggested metastatic adenocarcinoma with primary gastric malignancy. The patient and his family opted for palliative care and was discharged. Discussion: Gastric cancer accounts for 2-8% of overall UGIB and 58% bleeding risk compared to other GI malignancies. There are no specific guidelines and only limited evidence was available on managing malignancy-related UGIB. Nonresponsive, inoperable metastatic gastric cancer bleeding is challenging and extremely difficult to manage using conventional hemostasis techniques. Based on our case, we recommend utilizing Hemospray as a first-line, monotherapy or in combination to control bleeding until a definitive treatment, reducing morbidity and mortality.Figure 1.: (A) Submucosal gastric fundal mass distal to gastroesophageal junction with blood oozing from multiple sites (arrows), (B) Image showing endoscopic hemostatic clips placement (arrowheads), (C) Application of Hemospray over the Gastric Mass after unsuccessful attempts using standard-of-care hemostatic methods, (D) Showing embolization of the left gastroepiploic artery.

S2499 Gastric Adenocarcinoma After Sleeve Gastrectomy

Introduction: Gastric cancer remains the fourth most common cancer worldwide. Unfortunately, it is usually diagnosed in advanced stage. Risk factors include Helicobactor pylori, gastroesophageal reflux disease, and obesity. Reported cases of gastric cancer after bariatric surgery have been known to be anecdotal. Laparascopic sleeve gastrectomy for obesity is increasingly preferred by surgeons due to its easy technique combined with excellent weight loss results. However, recently there has been a rising incidence of gastric-esophageal cancers seen post bariatric surgery. Cancer in the distal stomach after gastric bypass was first described in 1991 in a female patient 5 years after the original procedure. We present a case who was found to have gastric adenocarcinoma 7 years post sleeve gastrectomy. Case Description/Methods: A 65-year-old Hispanic male presented to the emergency department with a complaint of vomiting for 10 days in duration. This was associated with epigastric pain and weight loss. His past medical history was significant for morbid obesity for which he underwent a gastric sleeve 7 years prior to presentation. He had GERD and H. pylori treated and eradicated with quadruple therapy. He did not report any family history of GI malignancies. On examination, the vital signs and physical examination were unremarkable. His laboratory values were normal as well. Abdominal radiography, right upper quadrant ultrasound and computed tomography did not show evidence of intra-abdominal pathology. Upper endoscopy showed a circumferential mass in the fundus of the stomach. A biopsy confirmed gastric adenocarcinoma with focal signet cell features. He was started on neoadjuvant therapy and had a J tube put in place in order to tolerate feeds. Discussion: The aim of this report is to show a case of de-novo gastric adenocarcinoma after bariatric surgery with sleeve gastrectomy. Although, obesity, a known risk factor for gastric carcinoma, increasing trends have been noted with rise in carcinoma after sleeve gastrectomy. It is not known whether bariatric surgery is the cause or the fact that patient had history of H. pylori treated that predisposed him to develop the malignancy. The relationship between bariatric surgery and subsequent gastric carcinoma needs further investigation. Patients might be at higher risk of developing gastric adenocarcinoma post sleeve gastrectomy especially if they have history of H. pylori infection in the past and this high-risk group might benefit from surveillance EGD.Figure 1.: Endoscopy: Circumferential mass in gastric body.

Gastric Metastasis of Primary Lung Cancer: Case Report and Systematic Review With Pooled Analysis

BackgroundGastric metastasis from lung cancer (GMLC) is a rare occurrence. The clinicopathological characteristics, outcomes, and prognostic factors remain largely elusive.MethodsWe conducted a systematic review on case reports and case series of GMLC by scanning MEDLINE, Embase, and ISI Web of Knowledge. Data involving the clinicopathological features, treatment, and outcomes were extracted and analyzed. Survival analysis was performed using Kaplan–Meier method. The Cox proportional hazards regression model was used to identify potential prognostic factors associated with survival. Furthermore, a case of metastatic gastric adenocarcinoma of pulmonary origin with epidermal growth factor receptor (EGFR) L858R+T790M mutation was also described and included.ResultsSeventy-eight records involving 114 cases (including ours) were finally included. The median age on admission was 65 years with a male predominance of 79.8%. Lung adenocarcinoma (42.1%), located in the right upper lobe (30.3%), was the most frequent primary tumor. Bleeding (36.7%) and abdominal pain (35.8%) were the two most common symptoms. Endoscopically, gastric lesions were typically presented as elevated lesions with or without volcano-like ulceration, or ulcerative lesions, mostly involving the gastric corpus. The median overall survival time and survival time after diagnosis of metastatic cancer were 11 months [95% confidence interval (CI): 7–14] and 4.5 months (95% CI: 3–9), respectively. The survival analyses revealed that surgical interventions (including lung surgery and/or abdominal surgery) and systemic therapy (including chemotherapy, radiotherapy, and/or targeted therapy) seemed to be positive prognostic factors for both overall survival and survival after diagnosis of metastatic cancer.ConclusionsClinicians should be alerted to the occurrence of gastric metastasis in lung cancer patients. Comprehensive evaluation and appropriate treatment for specific patients may improve the survival rate of GMLC patients.

Gastric Adenocarcinoma of the Remnant Stomach Presenting With a Cystic Intra-abdominal Mass 11 Years After Roux-en-Y Gastric Bypass.

CASE REPORT Morbid obesity defined as a body mass index of ≥ 40 kg/m2 is associated with increased morbidity and all-cause mortality.1 Roux-en-Y gastric bypass (RYGB) is the desired surgical intervention because of its proven benefits.1,2 Morbid obesity is associated with increased risk of gastric cancer; however, the altered anatomy of the stomach after bypass is challenging for ongoing surveillance of the remnant stomach.2 To date, only 17 cases of gastric remnant malignancy after RYGB are reported.2 We present a rare case of gastric remnant adenocarcinoma 11 years after RYGB presenting with abdominal pain and weight loss due to a large intra-abdominal cystic mass abutting the gastric remnant. Abdominal computed tomography without contrast revealed a large cystic structure abutting the stomach and pancreas (Figure 1). An esophagogastroduodenoscopy was normal. An endoscopic ultrasound (EUS) revealed a single round anechoic lesion >100 mm in size in the peripancreatic and perigastric peritoneal space (Figure 2). Typical mucosal, submucosal, and muscular propria layers were noted within the wall of the cystic structure without communication to the excluded stomach (Figure 3). Fine-needle aspiration of fluid (Expect 19 Gauge Flex Needle [Boston Scientific, Marlborough, MA]) demonstrated 750 mL of brown fluid with unremarkable cytology and normal lipase and amylase levels. The carcinoembryonic antigen (CEA) level in the cystic fluid was markedly elevated at 2,358 ng/mL when compared with serum CEA of 76.6 ng/mL.Figure 1.: Axial images of the abdomen and pelvis show the cystic dilation.Figure 2.: The cystic structure seen before fine-needle aspiration (FNA) (thick arrow).Figure 3.: Endoscopic ultrasound (EUS) images revealing the wall layers of the cystic structure (thick arrow) is seen after cyst fluid fine-needle aspiration (FNA), which demonstrates that it is not a cyst but a gastrointestinal structure.A second EUS performed because of recurrent abdominal distension showed a persistent cystic structure. Injection of contrast within the cystic structure demonstrated communication between the cyst and the excluded stomach. Fine-needle biopsy (Acquire 25 Gauge Needle [Boston Scientific]) of an area of the thickened gastric wall demonstrated poorly differentiated adenocarcinoma (Figure 4).Figure 4.: The area of the excluded stomach (thick arrow) with abnormal thickening of the stomach wall was biopsied revealing adenocarcinoma.Diagnosis of gastric remnant malignancy is usually confirmed at a median of 9 years after RYGB (range is 1–22 years) with abdominal computed tomography scans.2 EUS and transgastric endoscopy may be considered as alternatives to double-balloon enteroscopy for tissue biopsy in the setting of technically difficult access of the gastric remnant.3,4 Prevention and surveillance methods including remnant gastrectomy proposed in regions with a high prevalence of gastric cancer remain controversial and not well established. More studies are needed to determine whether CEA can be considered for screening of the cancer in the excluded stomach in patients with a history of morbid obesity and RYGB.5 DISCLOSURES Author contributions: GW Khneizer and BL Bick conceived and drafted the work. N. Mahendraker designed and critically revised the work, and all authors gave final approval of the version to be published and agreed to be accountable for all aspects of the work. GW Khneizer is the article guarantor. Financial disclosure: None to report. Informed consent could not be obtained from the family of the deceased. All identifying information has been removed from this case report to protect patient privacy.

A Case of Gastric Adenocarcinoma with Enteroblastic Differentiation

A Case of Gastric Adenocarcinoma with Enteroblastic Differentiation

Successful Treatment of a Major Leakage of an Esophagojejunal Anastomosis after Open Total Gastrectomy: A Case Report

Esophagojejunal leakage is one of the most serious complications in total gastrectomy surgery for proximal gastric cancer anastomotic leakage after this procedure occurs despite improvements in surgical techniques. Although many cases of dehiscence due to the medical condition of the patient can be managed non-operatively, major leakage requires second or more surgery. It can seriously lead to death or major complications.Case presentationThis report describes a 64-year-old man with a known case of proximal gastric adenocarcinoma, which underwent open total gastrectomy and esophagojejunal anastomosis. After the surgery, due to a major leak of anastomosis, which was diagnosed with oral gastrografin radiography pictures with patients fever and leukocytosis, the patient went to the operation room which at the second surgery esophagostomy and the jejunostomy feeding tube was inserted after six months esophagojejunotomy done and the patient tolerated the liquid and regular meals and was discharged.ConclusionMajor leakage of an esophagojejunal anastomosis is a severe complication of total gastrectomy. Although if the patient s condition tolerates the morbidity of this complication, re-anastomosis after six months of leakage is possible. Therefore, aggressive and urgent reoperation and effective drainage are useful once it is diagnosed.

A case of foveolar-type gastric adenocarcinoma with a raspberry-like appearance discovered during the Saitama City endoscopic gastric cancer screening program

A case of foveolar-type gastric adenocarcinoma with a raspberry-like appearance discovered during the Saitama City endoscopic gastric cancer screening program

A case of gastric adenocarcinoma extirpated with total gastrectomy involving jejunal pouch reconstruction

Gastric adenocarcinoma usually has a poor prognosis due to its late diagnosis in most cases. Gastric adenocarcinomas account for 95% of all malignant tumors of the stomach. In this report, we described a case of a 63-year-old man who presented with pain in the epigastric region for 1 month which was associated with hematemesis and loss of appetite. The upper gastrointestinal endoscopy (UGIE) revealed an ulcer of size 3 cm × 3 cm in the lesser curvature of the stomach. The patient underwent open total gastrectomy, dissection D2, and a jejunal pouch of 30 ml additional capacity was created 20 cm distal to duodenojejunal flexure and passed retrocolic from a rent in transverse mesocolon. The patient was sent to chemoradiotherapy after the surgery and discharged on the 24th day after surgery. Postoperative biopsy revealed tumor tissue showing irregular, ill-defined, and glandular clouding with loss of polarity. Infiltration was up to the muscularis layer and mesenteric lymph nodes showed partial effacement of architecture with reactive changes and few multinucleated foreign body giant cells confirming the diagnosis as poorly differentiated adenocarcinoma of the stomach of II B class (T2 N2 M0) as per the Union for International Cancer Control guidelines.

Clinical Complete Remission of An Advanced Gastric Adenocarcinoma After Camrelizumab Plus Chemotherapy Followed by Camrelizumab Plus Capecitabine: A Case Report

We report a rare case of PDL1-negative advanced gastric adenocarcinoma that improved significantly after camrelizumab plus chemotherapy followed by camrelizumab plus capecitabine as first-line therapy. A 65-year-old woman was diagnosed with a gastric adenocarcinoma in 2017 via contrast-enhanced computed tomography (CT) and endoscopic biopsy. She stabilised after preoperative neoadjuvant chemotherapy, surgery, and postoperative adjuvant chemotherapy. In September 2019, positron emission tomography (PET)/CT re-examination suggested a peritoneal metastasis and multiple lymph node metastases. She then received six cycles of camrelizumab plus chemotherapy. PET/CT indicated that the metastatic foci had disappeared and that she had achieved a clinical complete response(CCR). She was followed-up with camrelizumab plus capecitabine (maintenance therapy). At the time of writing, her progression-free survival is more than 14 months and her quality of life is good. Thus, camrelizumab plus chemotherapy is a useful first-line treatment for HER2- and PD-L1-negative advanced gastric adenocarcinoma.

S3715 A Leather Bottle Stomach: Rare Case of Gastric Adenocarcinoma With Signet Cell Features

Introduction: Gastric cancer is one of the most common cancers worldwide - and was previously the leader of cancer related mortality until the 1980’s. With advancements in discovery of etiologies, namely the detection of H. Pylori - incidence of gastric cancer has declined over the past decades. A common finding on imaging is the diffuse gastric wall thickening - the “leather water bottle” or Linitis Plastica. A representation of diffuse infiltration of the cancer into the wall of a hollow organ, in this case - the stomach, giving it’s rugged and preserved structural shape. We present a case of poorly differentiated gastric adenocarcinoma with signet ring cell features in setting of portal hypertensive gastropathy. Case Description/Methods: 70-year-old female with PMH of HCV (treated with SVR) and 20 pack year tobacco history presented with complaints of weight loss, decreased appetite and early satiety with no other complaints for one month. Physical exam significant for bi-temporal wasting otherwise unremarkable. Initial chemistries within normal limits. CT abdomen and pelvis revealing a prominent thickening of the wall of the stomach as well as inhomogeneous soft tissue attenuation in the omentum concerning for neoplastic disease. EGD showed evidence of portal hypertensive gastropathy with distal gastric body thickening in addition to the examined duodenum revealing duodenitis. Biopsies of the stomach revealed poorly differentiated adenocarcinoma with signet ring cell features while the duodenal mucosa was negative for significant histopathologic abnormality. H. pylori immunostain was negative. Insufficient tissue for HER2 and PDL-1 assessment. Oncology evaluation included PET CT with significant circumferential thickening and hypermetabolic activity of the stomach with additional focus of modular hypermetabolic activity at pyloric and duodenal 2nd portion suggestive of multi centric disease. Diffuse omental modularity and ascites at low level metabolic activity consistent with omental metastasis and malignant ascites. Discussion: While our patient presented late in the disease course, there are still available palliative chemotherapy opportunities. Advances have been made in molecular identification and subtypes within the gastric cancer umbrella for more targeted therapy. Recent FDA approval (April 2021) of the addition of Opdivo (immunotherapy) to FOLFOX (chemotherapy) for treatment of metastatic gastric cancer has allowed our patient to receive the most up to date treatment option.Figure 1.: Figures 1-A through C are endoscopic images of the gastric body (evidence of portal hypertensive gastropathy), the duodenal bulb (suggesting duodenitis) and the 2nd portion of the duodenum. Figure 1-D is a CT Abdomen-Pelvis with Contrast depicting the classic radiographic finding of gastric cancer - 'linitis plastica' with surrounding peri-gastric lymphadenopathy. Figures 1-E and F are NM PET scan's with evidence of diffuse hypermetabolic activity in the stomach wall with uptake of SUV max 10.1 in addition to the 2nd portion of the duodenum with uptake of SUV max 5.7 - suggestive of multi-centric disease.

S3082 A Rare Case of Gastric Adenocarcinoma of Fundic Gland Type in a White American Male

S3082 A Rare Case of Gastric Adenocarcinoma of Fundic Gland Type in a White American Male