What happened, in summary

A 52-year-old woman had 11 months of abdominal pain, intermittent black stools and weight loss. She underwent repeated endoscopies and biopsies because gastric cancer was strongly suspected, but each sample remained negative. Imaging showed progressive thickening and stiffness of the stomach wall, while endoscopic ultrasound and fine-needle sampling still failed to identify cancer cells.

As her symptoms worsened, a multidisciplinary team continued to recommend surgery despite the lack of a definitive biopsy. She ultimately agreed to an operation. Surgeons found diffuse thickening of the stomach with locally invasive disease and performed radical total gastrectomy with D2 lymph-node dissection, splenectomy and partial removal of the left adrenal gland.

Final pathology showed poorly differentiated signet-ring cell adenocarcinoma involving the full stomach wall. None of 32 lymph nodes contained cancer. The cancer was Stage II. Postoperative chemotherapy was recommended. She was alive at the latest follow-up.