What happened, in summary

About 2 years after curative endoscopic removal of an earlier gastric adenocarcinoma, surveillance found a new 8-mm lesion in another part of the stomach in the same patient. Biopsy initially showed differentiated adenocarcinoma, and the new tumor was removed by endoscopic submucosal dissection.

Final pathology, however, showed a rare gastric adenosquamous carcinoma with deep submucosal invasion and lymphovascular invasion. Because the endoscopic treatment was considered non-curative, additional gastrectomy was recommended. Before that surgery could proceed, CT performed 2 months later showed multiple liver metastases. The cancer was therefore metastatic, consistent with Stage IV disease, and surgery was no longer considered appropriate.

He began systemic chemotherapy. Despite treatment, the gastric cancer progressed, and he died 27 months after the second endoscopic resection. This second tumor was described as a metachronous gastric primary, separate from the well-differentiated early adenocarcinoma that had been removed 2 years earlier.