What happened, in summary

A 77-year-old woman was admitted after 4 days of dull upper abdominal pain. CT showed thickening of the stomach wall and a 70 mm rim-enhancing cystic mass extending from it. Endoscopy found an advanced cancer in the middle stomach, and biopsy showed tubular adenocarcinoma. Ultrasound through the endoscope confirmed a deep lesion and associated abscess. Drainage was attempted but removed only a small amount because bleeding obscured the view. One week of intravenous meropenem improved the inflammation, although the abscess remained.

The cancer was initially classified as cT4aN1M0, clinical stage III. She underwent distal gastrectomy with D2 lymph-node dissection and Roux-en-Y reconstruction. The mass was attached to the abdominal wall but could be separated and removed completely.

Pathology showed an 82 × 65 mm tumor invading the subserosa, composed of tubular adenocarcinoma with a neuroendocrine cell carcinoma component. The neuroendocrine component was synaptophysin positive and negative for CD56, chromogranin A, and SALL4. No lymph-node metastases were found, revising the pathologic stage to IIB, pT3N0. The abscess extended into the subserosa but had not broken through the outer stomach surface. Recovery was uncomplicated, and she remained disease-free during 22 months of follow-up.