黄**· 55

Huáng**, age 55. Due to difficulty in eating, gastroscopy was performed on 2023-02-07: tumor infiltration over a ~1.5 cm area near the cardia. Pathology: (cardia) poorly-differentiated adenocarcinoma. On 2023-02-17 at Xuhui Hospital affiliated with Fudan University (复旦大学附属徐汇医院), PET-CT combined with patient history revealed: peri-gastric and retroperitoneal lymph node metastases, diffuse hepatic metastases, solitary splenic metastasis, and metastasis on the right side of the S2 sacral vertebra. Given the widespread metastasis of the gastric malignancy, surgery was not feasible.

On 2023-03-21, during intervals between chemo- and radiotherapy, perinatal NK immune cells 2U administered, 5 consecutive infusions.

Diagnoses at admission / discharge

1. (Gastric cancer) palliative chemotherapy
2. Gastric malignancy with widespread metastases
3. Secondary malignancy of liver and intrahepatic bile ducts

Primary symptoms and examination (before)

The patient was admitted with difficulty in eating. On 2023-02-07 at an outside clinic, gastroscopy revealed tumor infiltration over ~1.5 cm near the cardia. Pathology: (cardia) poorly-differentiated adenocarcinoma. On 2023-02-12 the patient was admitted to our hospital for further examination. PET-CT: 1) Based on history, gastric cardia and lesser curvature malignancy with perigastric and retroperitoneal lymph node metastases, diffuse hepatic metastases, solitary splenic metastasis, and right-side S2 sacral metastasis; high suspicion of right parasternal metastasis. Given the widespread metastasis, surgery is not feasible. After oncology consultation, chemotherapy was initiated on 2023-02-16 (SOX+PD1 regimen, Q3W): oxaliplatin 200 mg d1 + tegafur 60 mg bid d1-d14 + sintilimab (Tyvyt) 200 mg d1.

Post-treatment follow-up PET-CT

Compared with our hospital's 2023-02-14 PET-CT scan:

• Gastric tumor lesion volume, count, and SUV uptake intensity significantly improved.
• Cardia and lesser curvature showed mild wall thickening with elevated FDG uptake, thickness ~0.8 cm, SUVmax ~4.3 — tumor lesion significantly reduced, metabolism markedly decreased.
• Perigastric and retroperitoneal lymph nodes significantly reduced in number and size, metabolism markedly decreased.
• Multiple low-density nodules in liver parenchyma with elevated metabolism; largest at hepatic hilum ~1.3×1.3 cm, SUVmax ~6.8 — significantly reduced, metabolism decreased.
• Focal mild metabolic uptake in upper pole of spleen, SUVmax ~2.9 — size unchanged, metabolism decreased.
• The right-side S2 sacral hypermetabolic lesion returned to baseline.

Reporting physician: Jin Yaohua (金耀华). Validator: Zhou Fa (周发). Institution: Shanghai Xuhui District Central Hospital / Xuhui Hospital affiliated with Fudan University, Department of Nuclear Medicine.