case_images: PMC10755568_01
case_images: (A) Gastroscopy revealed ulcer-like lesions in the small curvature of cardia and gastric body. (B) Pathological examination of a biopsy specimen found adenocarcinoma. (C) Enhanced CT showed that the abdominal and retroperitoneal lymph nodes had increased and enlarged. (D) Enhanced CT after MET targeted therapy showed that the abdominal and retroperitoneal lymph nodes had decreased than anterior. The arrow in (A) indicate the locations of ulcer-like lesions in the small curvature of cardia and gastric body. The arrow (C, D) indicate the locations of enlarged retroperitoneal lymph nodes.
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case_images: f1
case_images: He was admitted in July 2020 with a two-week history of "choking feeling following eating." Gastroscopy revealed ulcer-like lesions in the small curvature of the cardia and gastric body ( Figure 1A ). Pathological examination of a biopsy specimen identified adenocarcinoma ( Figure 1B ). Enhanced CT showed that the abdominal and retroperitoneal lymph nodes had increased and enlarged (the shortest diameter of the largest lymph node was about 1.6 cm) ( Figure 1C ). Enhanced CT after MET targeted therapy showed that the abdominal and retroperitoneal lymph nodes had decreased than previously ( Figure 1D ).
case_images: Comparison of genetic tests between March 2021 and October 2021. The symbol "-" means the TMB detection wasn't performed in October 2021.
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case_images: f2
case_images: TP53 mutation (77.33%), mesenchymal-epithelial transition factor proto-oncogene (MET) amplification (9.4x), CCND1 amplification (13.7x), and FGF19 amplification (12.9x) ( Figure 2 ). Treatment was changed to lenvatinib 8 mg 1/d+crizotinib 250 mg 2/d. TP53 mutation (74.85%), MET amplification (9.5x), MYC amplification (4.1x), CCND1 amplification (14.5x), and FGF19 amplification (14.3x) ( Figure 2 ).
case_images: (A) Enhanced CT showed tha the liver had new metastasis. (B) Enhanced CT showed the maximum short diameter of abdominal and retroperitoneal lymph nodes was increased, and the maximum long diameter of intrahepatic metastasis was larged. The arrows indicate the locations of new metastases in the liver and the locations of enlarged retroperitoneal lymph nodes.
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case_images: f3
case_images: After 2 months of continued oral capmatinib, CT revealed that the lesion was PD (the liver had new metastasis with a maximum diameter of 2.6 cm while the shortest diameter of the largest lymph node was 1.4 cm) ( Figure 3A ). After two cycles, the lesion was evaluated as PD (CT showed new metastases with the shortest diameter in the mediastinal lymph nodes of 1.7 cm and in the abdominal and retroperitoneal lymph nodes of 2.4 cm, whereas, the longest diameter in the intrahepatic metastasis was 3.4 cm) ( Figure 3B ).
case_images: Timeline for diagnosis and treatment form July 2020 to Feb 2022.
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case_images: f4
case_images: The patient died in February 2022 ( Figure 4 ), with an overall survival of 19 months.