What happened, in summary

A 51-year-old man was being followed after treatment for gastric cancer. His original tumor was a poorly differentiated tubular adenocarcinoma in the upper stomach. He had undergone total gastrectomy in 2006 for Stage II disease, followed by 6 cycles of cisplatin plus 5-fluorouracil chemotherapy.

About 5 years after surgery, imaging showed a small left adrenal mass. Because the finding was initially uncertain, it was observed. Six months later the mass had doubled to about 6 cm, and biopsy confirmed metastatic adenocarcinoma consistent with the gastric primary.

Roughly 6 years after the original gastrectomy, he underwent another major operation to remove the adrenal metastasis together with involved adjacent tissue, including the left kidney, part of the diaphragm, distal pancreas and spleen. Pathology confirmed metastatic gastric adenocarcinoma. He then received 8 cycles of S-1 chemotherapy.

At 13 months after the metastasis surgery, CT imaging and tumor-marker follow-up showed no evidence of recurrence. This placed him more than 7 years beyond his original gastric-cancer operation despite the late Stage IV recurrence.