Alhalabi Marouf M, Alsayd Saddam A, Albattah Mazen E
Department of Damascus Hospital, Damascus, Syria.
Resident at Damascus Hospital, Damascus, Syria.
Ann Med Surg (Lond). 2022 May 7;78:103728. doi: 10.1016/j.amsu.2022.103728. eCollection 2022 Jun.
Gastric cancer is a deadly disease with vague early symptoms. Its occurrence and prognosis in young patients have demonstrated significant variation and delay in detection, which is the most critical variable in disease prognosis.
We report a rare case of a 27-year-old Syrian female with metastasis diffuse gastric cancer with delayed diagnosis and poor prognosis without relevant history. She presented with two years of fatigue, loss of appetite, and postprandial abdominal pain, which has worsened over the past two months, vomiting, weight loss, and ascites. Gastroduodenoscopy showed superficial ulcers, with a positive Helicobacter Pylori infection. The computerized tomography (CT) scan revealed extensive thickening of the stomach, ascites, and Sister Mary Joseph nodule. The nodule tissue morphology coupled with immunostaining showed a poorly differentiated adenocarcinoma metastatic from the stomach. She was referred to a specialized oncology hospital for follow-up and palliative treatment.
Gastric adenocarcinoma affects people in their fifties and sixties, and rarely in their twenties. Risk factors include diet, smoking, alcoholism, long-term use of proton pump inhibitors, infection, pernicious anemia, and a genetic and family history of malignancies. Diagnosis at an early stage is essential in predicting prognosis. The diffuse gastric cancer spreads along the wall rather than into the lumen. The challenge is to detect tumors.
Gastric diffuse cancer screening and surveillance programs have yet to be defined. It is still unclear who should be screened when the screening should begin, and how the screening should take place.
胃癌是一种早期症状不明显的致命疾病。其在年轻患者中的发生和预后表现出显著差异，且检测延迟，这是疾病预后的最关键变量。
我们报告一例罕见病例，一名27岁的叙利亚女性患有转移性弥漫性胃癌，诊断延迟且预后不良，无相关病史。她出现了两年的疲劳、食欲不振和餐后腹痛，在过去两个月中症状加重，伴有呕吐、体重减轻和腹水。胃十二指肠镜检查显示浅表溃疡，幽门螺杆菌感染呈阳性。计算机断层扫描（CT）显示胃广泛增厚、腹水和库肯勃瘤。结节组织形态学结合免疫染色显示为胃来源的低分化腺癌转移。她被转诊至一家专业肿瘤医院进行随访和姑息治疗。
胃腺癌好发于五六十岁的人群，二十多岁的患者很少见。危险因素包括饮食、吸烟、酗酒、长期使用质子泵抑制剂、感染、恶性贫血以及恶性肿瘤的遗传和家族史。早期诊断对于预测预后至关重要。弥漫性胃癌沿胃壁扩散而非向腔内扩散。挑战在于检测肿瘤。
胃癌弥漫型的筛查和监测方案尚未明确。目前仍不清楚谁应该接受筛查、何时开始筛查以及如何进行筛查。
