What happened, in summary

A 60-year-old man was diagnosed with gastric carcinoma after evaluation for swallowing difficulty. He underwent distal gastrectomy with lymph-node dissection. Pathology showed gastric adenocarcinoma with both moderately and poorly differentiated components, 4 of 63 lymph nodes involved, and Stage II disease.

He started postoperative S-1 chemotherapy but stopped after the first cycle because of nausea, loss of appetite and weight loss. Twelve months after gastrectomy, CT found a small lesion in the spleen. PET-CT showed strong uptake in the splenic mass but no other suspected metastases, and repeat imaging 6 weeks later showed that the lesion had grown.

Because the splenic lesion remained isolated and resectable, he underwent splenectomy. Pathology confirmed that the splenic tumor matched the original gastric adenocarcinoma, establishing metastatic recurrence. He declined additional chemotherapy after surgery. At 18 months after splenectomy, he remained well with no evidence of another gastric cancer recurrence, approximately 2.5 years after his original gastrectomy.