A Case of Stage IV Gastric Cancer with Synchronous Pancreatic and Splenic Metastases Treated by Simultaneous Resection

Abstract

A 64-year-old man was diagnosed with Borrmann type 2 adenocarcinoma at the posterior wall of the gastric fundus. In addition to the primary tumor, CT showed another tumor of 20 mm in the pancreatic tail, which was suspected to be a primary cancer, endocrine tumor, or solid pseudopapillary neoplasm based on radiological examinations. Total gastrectomy with simultaneous distal pancreatectomy and splenectomy was performed under the diagnosis of gastric cancer and splenic tumor. However, histopathological examination showed that the pancreatic tumor had similar immunostaining features (CK20 and CK7-positive, CA19-9-negative) as the primary gastric cancer and another metastatic tumor in the spleen. The final diagnosis was Stage IV gastric cancer with synchronous metastases to the pancreas and spleen. After adjuvant chemotherapy, the patient has remained free of recurrence for 5 years. Since there are few case reports of simultaneous resection for gastric cancer with synchronous multi-organ metastases, this report implies that a radical surgical procedure might be a feasible option in selected cases even with synchronous multi-organ metastases.