Advanced diffuse gastric adenocarcinoma in young Syrian woman. A case report

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, Helicobacter pylori 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.