Gastric Adenocarcinoma

Abstract

A 14-year-old Hispanic previously healthy girl presented to the pediatric emergency department with 2-3 months of increasing epigastric abdominal pain. She was brought to the emergency department for an episode of waking pain. Family history was negative for gastric cancer. Physical examination revealed pallor and abdominal tenderness in her epigastrium and left upper quadrant. Initial evaluation revealed anemia (Hb 7.8 g/dL), elevated lipase (133 U/L), erythrocite sedimentation rate 78 mm/hour, aspartate aminotransferase 103 U/L, and alanine aminotransferase 69 U/L. Magnetic resonance enterography showed inflammatory change in the body and tail of the pancreas and prominent pancreatic and gastric lymph nodes. Esophagogastroduodenoscopy revealed a 5-6 cm gastric mass in the posterior wall of the stomach body/fundus with complex ulceration (Fig. 1). Pathologic analysis yielded poorly differentiated primary gastric adenocarcinoma (negative Helicobacter pylori staining) (Fig. 2). Staging studies showed stage IV disease because of tumor size T4b-extension of the mass to the pancreatic tail and left adrenal region, and distant lymph node involvement-Virchow's node. She did not respond to two cycles of chemotherapy. Palliative care was recommended, and she expired within 3 months of diagnosis. Gastrointestinal (GI) malignancy accounts for 5% of all pediatric neoplasms; gastric adenocarcinoma represents 0.05% of all childhood cancers (1).