A 54-year-old female patient with a past medical history of hypertension presented with abdominal pain and an episode of coffee ground emesis. Symptoms of pain and vomiting started approximately two to three months before admission and began to worsen over the past month. The pain was relieved by food. The patient also admitted to unspecified weight loss over the same period of time. On physical examination, mild distension of the abdomen was observed with a mild to moderate tenderness to palpation involving epigastric tenderness. An endoscopy of the upper gastrointestinal tract (EGD) revealed a gastric ulcer extending to the lower part of the stomach. No active bleeding was observed at the site. Gastric outlet obstruction was also noted with an inflamed edematous pylorus. Biopsy revealed a moderately differentiated gastric carcinoma. Staging CT-scan imaging studies revealed no sites of metastasis. The patient was diagnosed with stage II (cT3 cN0 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma. The patient was then taken to the operating room for laparoscopic subtotal gastrectomy with D2 lymphadenectomy. The operation time was 220 minutes. No further evidence of intra-abdominal disease or liver involvement was observed. The patient did well postoperatively and was subsequently discharged home on postoperative day 7. No metastatic lymph nodes / twenty-two regional lymph nodes were found; so the pathological findings confirmed stage II. The patient is disease-free at 12 months.
Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.

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