Abstract
Gastric cancer is the fifth most common malignancy and the third leading cause of cancer-related mortality worldwide, accounting for over 1.1 million new cases and 769 000 deaths annually. Among its histological subtypes, tubular adenocarcinoma comprises approximately 50 % of early gastric cancers and generally carries a more favorable prognosis compared to poorly differentiated variants.
We report the case of a 71-year-old male who presented with several weeks of progressive epigastric pain, vomiting, anorexia, and weight loss. Initial diagnostics—including two esophagogastroduodenoscopies (EGDs) with multiple biopsies—failed to confirm malignancy due to tumor location and sampling limitations. Contrast-enhanced computed tomography (CT) performed in June 2024 revealed focal gastric wall thickening along the lesser curvature and enlarged perigastric lymph nodes, suggestive of locoregional spread without distant metastases. By August 2024, his clinical condition deteriorated, with refractory vomiting and severe malnutrition (15 kg weight loss over three months), necessitating urgent surgical intervention. He underwent laparoscopic total gastrectomy with Roux-en-Y reconstruction and D2 lymphadenectomy. Histopathology confirmed a poorly differentiated tubular adenocarcinoma (ICD‐O‐8211/3), staged pT3N1M0, with perineural invasion but negative resection margins. Postoperative recovery was uneventful; adjuvant chemotherapy comprising 5‑fluorouracil, cisplatin, leucovorin, and folic acid was administered for three cycles. Follow-up imaging at three months showed no evidence of recurrence. HER2 testing was planned to assess eligibility for trastuzumab.
This case underscores the importance of an adaptive, multidisciplinary approach when standard diagnostic pathways are inconclusive. Early recognition of sampling limitations in cardia tumors, timely surgical intervention to secure both diagnosis and palliation, and appropriate adjuvant therapy are critical to optimizing outcomes in advanced gastric tubular adenocarcinoma.
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