What happened, in summary

A 65-year-old man developed several months of upper-abdominal discomfort and black stools before seeking care. Endoscopic biopsy showed gastric adenocarcinoma, and he arrived severely anemic from bleeding. After transfusions corrected the anemia, he underwent radical subtotal gastrectomy with D2 lymph-node dissection.

Pathology showed a rare mixed tumor: poorly differentiated gastric adenocarcinoma together with a choriocarcinoma component. The tumor extended through the stomach wall, and 1 of 38 regional lymph nodes contained cancer. The choriocarcinoma component produced large amounts of hCG, and tumor staining was also positive for HER2.

Soon after surgery, imaging showed a new lung nodule and multiple suspicious liver lesions. Within days, repeat CT demonstrated multiple lung and liver metastases and enlarged abdominal lymph nodes, establishing Stage IV disease. One liver metastasis ruptured and bled internally. Angiography confirmed the bleeding site, and transarterial embolization was performed to control the hemorrhage.

5-fluorouracil chemotherapy had been recommended, but he did not proceed with it and later declined further treatment. After discharge, his condition worsened rapidly. He died 18 days later from hemorrhagic shock related to the bleeding metastatic liver disease.