case_images: PMC10923592_01
case_images: Imaging examination prior to primary treatment. a Upper gastrointestinal endoscopy. A bulky ulcerated lesion was observed in the vestibular fontanel. Pyloric stenosis was not observed. b Computed tomography (CT) finding. The vestibular wall was abnormally thickened and showed hypoabsorption (red arrow), along with enlarged lesser curvature lymph nodes (blue arrow). c CT finding. A lymph node measuring up to 30 mm in the lesser curvature (blue arrow). d Positron emission tomography finding. There were significant accumulations in the lymph nodes of the lesser curvature (blue arrow) and hepatic S4 (yellow arrow).
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case_images: F1
case_images: Upper gastrointestinal endoscopy at our hospital revealed a type-2 lesion measuring 20 mm with an ulcer in the lesser curvature of the gastric antrum, and a biopsy revealed the presence of well-differentiated adenocarcinoma (tub1) (Fig. 1a). Computed tomography (CT) showed a tumor in the antrum and bulky lymph nodes with a minor radius of 30 mm in the lesser curvature and intramesenteric lymph nodes on the ventral side of the left kidney (Fig. 1b, c). Positron emission tomography revealed significant accumulations, with an SUVmax of 4.4 in liver S4 and 7.2 in the lesser curvature lymph nodes (Fig. 1d).
case_images: CT images to evaluate efficacy 3 months after the start of primary treatment. a Improvement in wall thickening of the primary lesion in the vestibular area was observed. b The lesser curvature lymph node showed a reduction to 16 mm (blue arrow).
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case_images: F2
case_images: CT for efficacy evaluation after three courses of primary treatment showed improvement in wall thickening in the gastric antecubital region and a reduction in the size of metastatic lymph nodes (lesser curvature lymph node, 16 mm), resulting in a judgment of partial response (Fig. 2).
case_images: CT images at the judgment of progress of disease after primary treatment. a The presence of pleural ascites and a pelvic dissemination site was noted (red arrow). b The lesser curvature lymph node had reduced in size and was no longer visible (blue arrow). Ascites was observed throughout the abdominal cavity.
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case_images: F3
case_images: However, a CT scan conducted 9 months after treatment initiation revealed the presence of ascites and pelvic disseminated nodes, leading to a diagnosis of progressive disease (Fig. 3).
case_images: Imaging examination during 3rd treatment. a CT finding. Ascites had disappeared, and metastatic lymph nodes had shrunk and were no longer visible. b Upper gastrointestinal endoscopy showed scarring of the primary lesion.
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case_images: F4
case_images: Thirty months later (43 courses), CT showed no apparent recurrence, and the CR was maintained (Fig. 4a). Biopsy results revealed no malignant cells (Fig. 4b).
case_images: PMC10923592_02