Multimodal approach enables R0 resection in advanced gastric adenocarcinoma with enteroblastic differentiation complicated by portal vein tumor thrombus.
Masateru Yamauchi, Keiji Nishibeppu, Takeshi Kubota et al.
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Case in brief
A 73-year-old woman with stage IV gastric adenocarcinoma with enteroblastic differentiation (GAED) had portal vein tumor thrombus (PVTT). Multimodal treatment included S-1 plus oxaliplatin, regimens incorporating nivolumab, and radiotherapy directed at the PVTT, without major adverse events. Imaging showed substantial shrinkage of the primary tumor and lymph nodes and disappearance of the PVTT. Laparoscopic distal gastrectomy with D2 dissection achieved R0 resection. Pathology confirmed GAED, ypT2N1M0, Stage IIA, with a Grade 1b response.
What made this case unusual
Despite stage IV GAED complicated by PVTT, the thrombus disappeared on imaging after multimodal therapy, allowing R0 resection.
Diagnostic / clinical pearl
In this case, radiotherapy for PVTT within a multimodal regimen was followed by thrombus disappearance and R0 resection; reassessment of resectability after treatment may be informative.