An inguinal hernia revealing an advanced stage gastric cancer in a young patient: A case report

Abstract

Introduction: Gastric cancer (GC) is the fifth most common cancer and the fourth leading cause of death. It is much more common in advanced age and it is rare among the youngest patients (under 45 years of age).

Case presentation: we report an unusual presentation of advanced gastric adenocarcinoma in 39-year-old man, who presented to our hospital with inguinal hernia without obvious gastrointestinal symptoms. He had strong family history of cancer, heavy smoking habit and weight loss. The intra-operative procedure identified a cyanotic separate spermatocele which was confirmed by the urologist. During investigation we found multiple liver metastasis in abdominal CT and advanced gastric adenocarcinoma from gastric biopsy and metastasis in spermatic cord sample and peritoneum sample of poorly differentiated adenocarcinoma.

Conclusion: Although stomach adenocarcinoma is extremely rare in young patient but it should be kept in mind of physicians as a possible diagnosis if there are many risk factors.

Keywords: Adenocarcinoma; Cancer; Case report; Gastric; Young.

Fig. 1

Intraoperative procedure showed a cyanotic separate spermatocele.

Fig. 2

Abdominal ct scan showed multipe metastasis in liver and free fluid around the liver and spleen.

Fig. 3

Peritoneal metastasis during laparoscopy.

Fig. 4

Histopathology examination of samples: (a) From gastric wall biopsy revealed proliferation of malignant epithelial cells composed of sheets and few glandular formations with hyperchromatic nuclei, prominent nucleoli and bizarre mitosis. (b) From the spermatic cord metastasis that revealed malignant epithelial proliferation mad up solid sheets and nests of round to oval tumor cells, showing oval hyperchromatic nuclei with prominent nucleoli and high mitotic figures. Some of tumor cells had signet ring-like appearance. (c) Immunohistochemical stains: CK7: positive, CK20, PLAP,CDx2: negative. (d) From peritoneal metastasis revealed malignant epithelial proliferation composed of solid sheets of round to oval tumor cells, that had vesicular nuclei, prominent nucleoli and some cells had signet ring-like appearance.