P1649 - An Unexpected Case of Gastric Adenocarcinoma in a Patient with No Known Risk Factors

Ahmer Khan, MBBS¹, Aniesha Kennedy, MD¹, Olatunde Kuponiyi, DO¹, Katarzyna Perkowska, MD¹, Kinga Grzybowski, MD¹, Sabin Tripathee, MBBS¹, Matthew Chan, DO², Michael Goldberg, DO^1
1Einstein Healthcare Network, Philadelphia, PA; ²Einstein Healthcare Network, East Norriton, PA

Introduction: Gastric cancer is the fifth leading cause of cancer worldwide. In the US, gastric cancer is diagnosed in over 26000 patients and results in approximately 11000 deaths annually. Patient factors that increase risk include H. pylori infection, preserved foods, nitroso compounds, alcohol, obesity, tobacco and occupational exposure. Gastric cancer development in patients at average risk involves an interplay of bacterial, host, and environmental factors. We describe a case of gastric adenocarcinoma in a patient with no risk factors for this disease

Case Description/Methods: A 32-year-old male with no significant medical or surgical history presented to the GI clinic with a complaint of nausea and vomiting for 2 weeks. He also reported excessive bloating and flatulence. A trial of OTC medications including docusate and senna did not provide relief. He endorsed a 30-pound weight loss over the past year, attributed to stress. Due to persistent symptoms, he presented to the ER. He was hemodynamically stable and laboratory findings were unremarkable.

CT scan of the abdomen and pelvis demonstrated infectious or inflammatory gastroenteritis with ileus. Upper endoscopy demonstrated LA grade D esophagitis and erosive and erythematous gastropathy in the body and fundus of the stomach. Biopsies revealed diffuse type gastric adenocarcinoma. He was managed supportively, and an NG tube was placed for decompression. Given an inability to tolerate oral intake and persistent abdominal distension, he was transferred to another facility for further multidisciplinary care and initiation of TPN. Helicobacter immunostaining was negative for organisms. Biopsy specimens of the stomach came back positive for diffuse type gastric carcinoma with immunohistochemical staining positive for AE1/3, supporting the diagnosis. He successfully underwent subtotal gastrectomy with ileocolic bypass

Discussion: The diffuse type of gastric adenocarcinoma is equally frequent in both genders, more common in younger age groups, and has a worse prognosis than the intestinal type. Mortality rates are high as most patients present with advanced disease. There has been an increase in the incidence of gastric cancer among young adults (aged < 50 years) worldwide. Gastrectomy is the most widely used therapy for invasive gastric cancer. Complete resection is the single strongest predictor of long-term survival; poor outcomes with surgery alone provide the rationale for adjuvant and neoadjuvant approaches using chemotherapy, radiation therapy or both



Disclosures:


Ahmer Khan, MBBS¹, Aniesha Kennedy, MD¹, Olatunde Kuponiyi, DO¹, Katarzyna Perkowska, MD¹, Kinga Grzybowski, MD¹, Sabin Tripathee, MBBS¹, Matthew Chan, DO², Michael Goldberg, DO¹. P1649 - An Unexpected Case of Gastric Adenocarcinoma in a Patient with No Known Risk Factors, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.