What happened, in summary

A 71-year-old woman developed nausea, indigestion, and marked weight loss. Evaluation found a very large tumor centered in the gastric cardia. Biopsy and molecular testing showed a rare SMARCA4-deficient undifferentiated carcinoma, including loss of SMARCA4/BRG1 expression and a SMARCA4 frameshift mutation.

She underwent total gastrectomy with lymph-node dissection together with removal of part of the pancreas and colon because the tumor directly invaded nearby organs. No pelvic tumor deposits were found during surgery. However, a CT scan only one week later showed multiple new liver metastases, indicating very rapid disease progression.

Paclitaxel plus carboplatin chemotherapy was started. Imaging after the first cycle showed stable disease, but her overall condition had deteriorated too much to proceed with a second cycle. She was transferred to another hospital for hospice care. Her course illustrates the aggressive behavior of this uncommon gastric carcinoma despite major surgery and attempted systemic treatment.