Gastric cancer with Virchow's and multiple lung metastases showing a remarkable response to preoperative chemotherapy: Report of a case

We report herein a rare case with advanced gastric cancer combined with gro up 4 lymph node and lung metastases that responded remarkably to neoadjuvan t chemotherapy. A 65-year-old man was found to have a well-differentiated t ype 3 gastric cancer that invaded the duodenum locally and was accompanied with Virchow's, para-aortic lymph nodes, and multiple lung metastases based on physical, endoscopic, and radiological examinations. In addition, his c arbohydrate antigen (CA) 19-9 was elevated to 3965 U/ml, and CA72-4 to 46 U /ml. Prior to surgery, he was treated with 5-fluorouracil (5-FU; 500 mg/bod y per day) and low-dose cisplatinum (CDDP; 10 mg/body per day) as neoadjuva nt chemotherapy for 6 weeks. As a result, a partial response was obtained i n all lesions, and CA19-9 and CA72-4 decreased to 463 U/ml and 9.4 U/ml, re spectively. Four weeks after the completion of neoadjuvant chemotherapy, a distal gastrectomy was performed, and a histopathological examination of th e resected specimen showed a grade 2 response to chemotherapy. Immunohistoc hemically, the thymidylate synthase expression level was very low in the tu mor tissues, which might account for the good response to the combination c hemotherapy with 5-FU and CDDP observed in the present case.