A 53-year-old female, with Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0, and a background history of hypertension and dyslipidemia. Due to heartburn, nausea and postprandial fullness, she underwent an upper digestive endoscopy with a biopsy, which revealed a gastric adenocarcinoma. Complete staging (including diagnosis laparoscopy) was cT4N+M0. The case was discussed in a multidisciplinary team meeting, and the patient was proposed for perioperative chemotherapy (ChT) with cisplatin/5-fluorouracil (CF) followed by gastrectomy. The anatomopathological examination of the surgical specimen revealed "slightly cohesive cells with infiltrating signet ring type," staged as ypT3N2G3. She completed three cycles of CF after surgery in June 2017. A year after the completion of ChT, the patient started complaining of incontinence and haematuria. She underwent a bladder ultrasound, which revealed "bladder thickening and left pyelocaliceal dilatation; a transurethral resection of a 4cm lesion of the bladder fundus revealed an adenocarcinoma with signet ring cell morphology compatible with a bladder metastasis of the gastric neoplasia" (Figure 1). Palliative ChT with 5-fluorouracil/oxaliplatin (FOLFOX6) regimen was started; however, the patient died after the third cycle due to disease progression.
Clinical case 2