What happened, in summary

A 74-year-old woman with diabetes and heart disease had previously undergone endoscopic removal of 3 early gastric cancers 5 years earlier. She continued endoscopy every 6 months. Eleven months before her later operation, the stomach looked unchanged, but 5 months before surgery a small 3 mm bulge appeared near an old treatment scar.

The first biopsy was not diagnostic. Three months later, the lesion had grown to about 6 mm and developed a central depression. Repeat biopsy showed neuroendocrine carcinoma. CT found no metastases, and the cancer was classified as Stage I. While her heart disease was being evaluated before surgery, the tumor continued to enlarge and exceeded 10 mm within another month.

She underwent distal gastrectomy 2 months after the neuroendocrine carcinoma diagnosis. Pathology confirmed a pure gastric neuroendocrine carcinoma without an adenocarcinoma component. Although the tumor was still Stage I with no cancer in 24 removed lymph nodes, microscopic examination showed lymphatic and venous invasion, underscoring its aggressive biology.

Because she was older, had underlying heart disease and had Stage I disease, postoperative chemotherapy was not given. She was followed closely and remained free of recurrence and metastasis for 18 months after surgery.