What happened, in summary

A man in his early 70s presented with worsening pain after meals, black stools, nausea, and a 3-kg weight loss over 1 month. Endoscopy found a large tumor on the lesser curvature of the stomach. He underwent total gastrectomy in January 2021. Pathology showed gastric large-cell neuroendocrine carcinoma with a small adenocarcinoma component and no malignant lymph nodes.

After recovering from surgery, he received cisplatin and fluorouracil chemotherapy and continued regular CT and endoscopic follow-up. In November 2021, imaging found a solitary 2.7-cm right adrenal mass while the liver, kidneys, spleen, and pancreas remained free of new abnormalities. He underwent laparoscopic adrenalectomy. Pathology confirmed that the adrenal tumor was metastatic large-cell neuroendocrine carcinoma matching the gastric primary, establishing distant metastatic disease.

He developed adrenal insufficiency after the adrenal operation and received hydrocortisone replacement. He recovered and continued outpatient follow-up. CT in August 2022 showed no new metastases or tumor recurrence. At the latest reported follow-up, he remained alive at least 9 months after removal of the adrenal metastasis. Nine months after adrenal surgery, he was alive with no evidence of new or recurrent disease on CT while continuing surveillance.