History

Levine Cancer Institute
Presented by: Dr. Jimmy Hwang
Patient: Gastric adenocarcinoma

Presented in summer of 2015 with back pain, malaise
On evaluation, found to have Tbili 6.3, ALT 534, AST 238 (normal in 2014)
RUQ U/S showed fatty infiltration, but no masses
MRI of abdomen demonstrated intrahepatic, extrahepatic biliary ductal dilatation, with stricture in proximal common bile duct; multiple peripancreatic, celiac, portocaval LN up to 2.6 cm, and lobulated enhancing appearance to proximal stomach wall, measuring up to 5 cm.
EGD demonstrated a large, submucosal noncircumferential mass at the GEJ/gastric cardia.
- Biopsy demonstrated adenocarcinoma, intestinal type
- HER2 amplified (HER-2: CEP17 ratio of 4.8)
PET/CT demonstrated hypermetabolic soft tissue thickening in the GEJ and cardia, measuring up to 40 mm; multiple hypermetabolic pulmonary nodules up to 1.6 cm, and hypermetabolic mediastinal, bilateral hilar, retroperitoneal/paraortic and peripancreatic LN; hypermetabolic 24 mm right adrenal lesion

Gastric adenocarcinoma