[Upper Gastric Poorly Differentiated Adenocarcinoma with a Giant Ulcer That Regressed Due to the Malignant Cycle-A...

This case is that of an 84‒year‒old woman in whom upper gastrointestinal endoscopy revealed a giant ulcerative lesion with irregular margins on the upper curvature of the stomach. Abdominal contrast computed tomography(CT)showed marked thickening of the stomach wall in contact with the pancreatic body and enlargement of the regional lymph nodes, suggesting a tumor metastasis to the lymph nodes. At the patient's request, she was followed‒up without surgery, and 8 months later, upper gastrointestinal endoscopy revealed that the ulcerative lesion was scarred and covered with a non‒ tumor mucosa. Contrast CT showed an improvement in the thickening of the stomach wall and shrinking the enlarged lymph nodes. She is currently being followed‒up in an outpatient clinic with no progression since 1 year 8 months. Total gastrectomy for the elderly is associated with perioperative complications and postoperative loss of appetite, which may lead to a decreased QOL. For gastric cancer cases with giant ulcers, it is necessary to carefully consider the surgical indications, bearing in mind the malignant cycle and perforation complications.