What happened, in summary

A 65-year-old woman was investigated for severe anemia, malaise and dizziness. Endoscopy showed a large bleeding tumor in the upper stomach. Biopsy initially suggested tubular adenocarcinoma, but surgery revealed a rare primary gastric choriocarcinoma with lymph-node and liver metastases, making the disease Stage IV.

She underwent total gastrectomy with extensive lymph-node surgery, distal pancreatectomy, splenectomy and removal of the liver nodule. Within a week, new liver lesions appeared. She began EMA/CO chemotherapy, and after 3 cycles the liver tumors disappeared on imaging and the tumor marker β-hCG fell to near-normal levels, producing a clinical complete response.

Six months after surgery, β-hCG rose again and multiple lung metastases appeared. EMA/CO was restarted and most lung lesions disappeared after one cycle. One remaining left-lung nodule was treated with CT-guided radiofrequency ablation. She remained alive with no evidence of disease for 9 years after that procedure, representing more than 9 years of survival from her original diagnosis.