2026-08-13 | Case Report: Synchronous Esophageal Squamous Cell Carcinoma and Gastric Cardia Adenocarcinoma with Hepatoid Differentiation After Neoadjuvant Chemoimmunotherapy.
Background/Objectives: Hepatoid adenocarcinoma is a rare adenocarcinoma subtype. Synchronous esophageal squamous cell carcinoma (ESCC) and gastric cardia adenocarcinoma with hepatoid differentiation is exceptionally uncommon. This report describes lesion-specific staging, pathological response assessment, and individualized management after neoadjuvant chemoimmunotherapy. Methods: De-identified clinical, imaging, laboratory, operative, and pathological data were retrospectively reviewed. Both lesions were staged according to the AJCC 8th edition and reassessed using the CAP modified Ryan four-tier tumor regression grading system. Results: A 61-year-old man presenting with dysphagia had separate ESCC and gastric cardia adenocarcinoma, both staged cT2N0M0. One cycle of pembrolizumab 200 mg, nab-paclitaxel 300 mg, and cisplatin 100 mg was administered. Agranulocytosis precluded further neoadjuvant therapy; after neutrophil recovery, R0 resection was performed. Pathological review showed ESCC ypT1aN0M0, score 1, and cardia adenocarcinoma ypT1aN0M0, score 3, with approximately 30% regional hepatoid differentiation. All 10 examined lymph nodes were negative. AFP was not measured before treatment; post-treatment/preoperative values were 14.45 and 14.68 ng/mL, and the postoperative value was 6.08 ng/mL. Postoperative tislelizumab monotherapy was selected as an individualized, non-standard strategy, mainly because of affordability. At approximately 6 months after surgery, no recurrence, metastasis, or maintenance-related adverse event was identified. Conclusions: This case emphasizes biopsy under-sampling and lesion-specific staging and pathological assessment. The regression-score difference is descriptive and confounded by baseline burden, histology, and one-cycle exposure; the AFP findings do not validate a surveillance biomarker.
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2026-08-10 | An example of successful combination treatment of a patient with primary multiple synchronous squamous cell carcinoma of the esophagus and squamous cell carcinoma of the stomach
Our work presents an extremely rare case of primary synchronous tumors in the esophagus and stomach with a similar histological type, with a different approach to treatment in a young patient. The high sensitivity of squamous cell carcinoma to drug therapy was vividly reflected in our example and clinically proven in the form of complete tumor resorption in the esophagus. Despite the generally accepted standards of treatment, we were dictated an individual treatment plan, thanks to which we managed to limit ourselves to gastric surgery, thereby avoiding the extended resection stage on the esophagus, thereby maintaining an optimal quality of life.
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2026-08-07 | Postoperative Adjuvant Treatment Decision for Early Epstein-Barr Virus-Associated Gastric Cancer.
Epstein-Barr virus-associated gastric cancer (EBVaGC) is a relatively rare clinical subtype. Despite its generally favorable prognosis, preoperative diagnosis remains challenging, and no established consensus exists regarding postoperative adjuvant treatment strategies for early-stage patients with high-risk pathological factors. This study reports a female case of early-stage EBVaGC of the lymphoepithelioma-like carcinoma subtype complicated with perineural invasion (a high-risk factor), and systematically explores the etiology, pathological features, key diagnostic points, individualized adjuvant therapy options, and prognosis of EBVaGC. The aim is to improve clinicians' understanding of this gastric cancer subtype, reduce its misdiagnosis rate, and accelerate the development of standardized diagnostic and treatment pathways. A case of a 60-year-old female patient admitted with "abdominal pain and distension for more than 1 year" was reported, and postoperative pathology confirmed EBVaGC. The clinical manifestations and diagnostic and treatment process were analyzed in combination with a review of relevant literature from recent years. Preoperative gastroscopic biopsy revealed poorly differentiated adenocarcinoma of the gastric mucosa. The patient underwent laparoscopic radical subtotal gastrectomy with lymph node dissection. Postoperative pathology confirmed EBVaGC. After symptomatic treatment, the patient improved and was discharged from the hospital. One month after surgery, no disease progression was observed and the SOX regimen was administered. The patient tolerated the treatment well, and the next cycle of chemotherapy is currently planned. EBVaGC lacks specific clinical manifestations, and laboratory findings may be within normal ranges at the time of onset. Reliance solely on conventional gastroscopy and histopathological biopsy can easily lead to misdiagnosis and inappropriate treatment. Epstein-Barr virus-encoded RNA in situ hybridization is the core diagnostic modality for definitive diagnosis. This subtype generally has a favorable prognosis. However, for patients with high-risk pathological factors such as perineural invasion and tumor invasion into the muscularis propria, standardized postoperative individualized adjuvant therapy should be administered based on tumor stage and molecular profiles.
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2026-08-07 | Capmatinib for High-Level MET-Amplified Metastatic Gastric Cancer Identified by Comprehensive Genomic Profiling: A Case Report and Literature Review.
High-level MET gene amplification is a rare but potentially actionable alteration in gastric cancer. Previous phase III trials of MET-targeted therapies enrolled broadly MET-positive populations without prospective selection for high-level MET amplification, and no MET-directed therapy is currently established for this disease. Here, we report a 74-year-old woman with heavily pretreated metastatic gastric adenocarcinoma harboring high-level MET amplification (copy number 21) identified by comprehensive genomic profiling. Following expert panel review, the patient received capmatinib through the BELIEVE trial (NCCH1901; jRCTs031190104) and achieved a confirmed partial response at 8 weeks, with a 43.7% reduction in the sum of target lesion diameters. The response was maintained at 16 weeks; disease progression was observed at 24 weeks, with a progression-free survival of approximately 5.5 months. In the context of a literature review of MET-targeted therapies in gastric cancer, this case supports further investigation of selective MET inhibition in gastric cancer with high-level MET amplification, a rare molecular subset not prospectively enriched in previous clinical trials.
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2026-08-05 | Durable response to ALK inhibition in low-allele-frequency SPTBN1-ALK-rearranged gastric cancer followed by lineage plasticity-mediated resistance: a case report.
ALK rearrangements are rare in gastric cancer, and their therapeutic relevance remains poorly defined. While ALK inhibitors have demonstrated efficacy in lung cancer and other malignancies, data in gastric tumors are limited. We report a 52-year-old woman with metastatic gastric adenocarcinoma harboring a rare SPTBN1-ALK fusion detected at a low variant allele frequency (0.65%). The tumor was negative for HER2 amplification, microsatellite instability, and PD-L1 expression. After failure of chemotherapy combined with immunotherapy, treatment with the ALK inhibitor iruplinalkib resulted in rapid clinical improvement and a durable partial response lasting approximately 14 months. Serial next-generation sequencing at progression demonstrated enrichment of the fusion-positive clone (variant allele frequency increased to 5.94%), accompanied by expansion of TP53-mutant alleles and acquisition of additional genomic alterations. Subsequent histologic transformation to small-cell neuroendocrine carcinoma was observed, with loss of RB expression and markedly elevated Ki-67. No canonical ALK kinase domain resistance mutations were detected, suggesting a non-on-target resistance mechanism. This case highlights that even low-allele-frequency ALK fusions may have important clinical relevance in gastric cancer and may identify patients who could benefit from ALK-targeted therapy. It also illustrates the dynamic evolutionary trajectory of oncogene-driven tumors under therapeutic pressure, with histologic transformation to small-cell neuroendocrine carcinoma that may reflect lineage plasticity. Comprehensive genomic profiling and longitudinal molecular monitoring may facilitate the identification of rare actionable alterations and improve understanding of resistance mechanisms in advanced gastric cancer.
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