Metastatic Lymphadenopathy As the Initial Presentation of Gastric Carcinoma: A Case Report

Gastric cancer in younger adults is relatively uncommon and may present with nonspecific or atypical clinical manifestations, which can contribute to delayed recognition.Signet-ring cell adenocarcinoma is a distinct histological subtype of gastric cancer that has been described in association with diffuse growth patterns and advanced disease in some patients.These features may contribute to diagnostic challenges, particularly when gastrointestinal symptoms are absent or nonspecific.We report the case of a 41-year-old male who was referred for evaluation of incidentally discovered abnormal liver function tests with an obstructive pattern during routine assessment.The patient reported approximately 10 kg of unintentional weight loss over six months but denied any localized gastrointestinal symptoms.Initial abdominal ultrasound revealed only mild fatty liver changes.Subsequent evaluation with magnetic resonance cholangiopancreatography (MRCP) demonstrated multiple enlarged conglomerate lymph nodes involving the porta hepatis, superior mesenteric, and peripancreatic regions.Histopathological assessment of a mesenteric lymph node biopsy revealed metastatic carcinoma of probable gastrointestinal origin, with tumor cells positive for AE1/AE3, CK20, CK19, and CDX2 on immunohistochemistry. Esophagogastroduodenoscopy (EGD) identified a large ulcerative gastric lesion along the greater curvature of the stomach.Histopathological analysis of gastric biopsies demonstrated poorly differentiated signet-ring cell adenocarcinoma associated with Helicobacter pylori infection.The patient was referred to the oncology service for further management.Younger patients with gastric cancer may present with advanced disease and atypical manifestations, contributing to delayed diagnosis.This case is notable for its atypical presentation with obstructive liver function abnormalities and metastatic intra-abdominal lymphadenopathy preceding identification of the primary gastric lesion.The case emphasizes the diagnostic importance of histopathological and immunohistochemical evaluation in patients with unexplained intra-abdominal lymphadenopathy.This case highlights the importance of maintaining a broad differential diagnosis in patients presenting with unexplained laboratory abnormalities or atypical radiological findings, even in the absence of gastrointestinal symptoms.Prompt histopathological evaluation, appropriate immunohistochemical analysis, and timely endoscopic assessment can facilitate identification of the primary tumor and establishment of the diagnosis.