Pathological Complete Response and Conversion Gastrectomy after Nivolumab Plus FOLFOX in an 84-Year-Old Man with MSI-High Gastric Cancer Presenting as a Sister Mary Joseph Nodule: A Case Report
Abstract
A Sister Mary Joseph nodule is a cutaneous umbilical metastasis indicating advanced intra-abdominal malignancy with a poor prognosis. An 84-year-old man presented with an umbilical nodule that was completely excised and diagnosed to be metastatic adenocarcinoma from advanced gastric cancer. After FOLFOX-nivolumab, the primary lesion and lymphadenopathy showed near-complete radiographic regression, and conversion total gastrectomy achieved a pathological complete response. The indications for surgery were insufficient, and therefore systemic therapy or surveillance was continued. This case highlights the uncertainty surrounding conversion surgery after an immune checkpoint inhibitor-induced near-complete response and suggests that neither umbilical metastasis nor advanced age alone should preclude the consideration of curative-intent multimodal treatment in fit patients.
Related
- Merkel Cell Polyomavirus-Negative Merkel Cell Carcinoma Presenting in the Parotid Gland: Precise Diagnosis and Complete Pathological Response to Nivolumab.
- Pathological Complete Response and Successful Conversion Hepatectomy in Initially Unresectable Giant Hepatocellular Carcinoma Following Triple Therapy With HAIC, Bevacizumab, and Tislelizumab: A Case Report
- Late Recurrence of Gastric Signet-Ring Cell Carcinoma Presenting as Pulmonary Metastasis 18 Years after Gastrectomy: A Case Report and Literature Review
- The added value of contrast-enhanced ultrasonography to BI-RADS in the evaluation of breast lesions presenting with pathological nipple discharge
- Magnetic Duodeno-Ileostomy as a Conversion Procedure After Sleeve Gastrectomy: First Single-Centre Experience in Colombia
BibTeX
@article{suzuki2026pathological,
title = {{Pathological Complete Response and Conversion Gastrectomy after Nivolumab Plus FOLFOX in an 84-Year-Old Man with MSI-High Gastric Cancer Presenting as a Sister Mary Joseph Nodule: A Case Report}},
author = {Shuhei Suzuki and Yuka Kobayashi and Takashi Oizumi and Erina Yakuwa and Rintaro Ohe},
journal = {Internal Medicine},
year = {2026},
month = sep,
doi = {10.2169/internalmedicine.7883-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7883-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pathological Complete Response and Conversion Gastrectomy after Nivolumab Plus FOLFOX in an 84-Year-Old Man with MSI-High Gastric Cancer Presenting as a Sister Mary Joseph Nodule: A Case Report
AU - Shuhei Suzuki
AU - Yuka Kobayashi
AU - Takashi Oizumi
AU - Erina Yakuwa
AU - Rintaro Ohe
PY - 2026
DA - 2026/09/01
JO - Internal Medicine
DO - 10.2169/internalmedicine.7883-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7883-26/_article
AB - A Sister Mary Joseph nodule is a cutaneous umbilical metastasis indicating advanced intra-abdominal malignancy with a poor prognosis. An 84-year-old man presented with an umbilical nodule that was completely excised and diagnosed to be metastatic adenocarcinoma from advanced gastric cancer. After FOLFOX-nivolumab, the primary lesion and lymphadenopathy showed near-complete radiographic regression, and conversion total gastrectomy achieved a pathological complete response. The indications for surgery were insufficient, and therefore systemic therapy or surveillance was continued. This case highlights the uncertainty surrounding conversion surgery after an immune checkpoint inhibitor-induced near-complete response and suggests that neither umbilical metastasis nor advanced age alone should preclude the consideration of curative-intent multimodal treatment in fit patients.
SN - 1349-7235
SN - 0918-2918
ER -