Background: Tumor relapse usually develops within the first years after surgery for stomach carcinoma. Most frequently it involves the gastric stump, lymph nodes, liver and peritoneum. We observed a case of late local recurrence of gastric cancer with unusual pattern of metastases and clinical manifestation. Case Report: A 53-year-old man was admitted to the Center in September 2001; 12 years before he underwent a multimode treatment (preoperative radiotherapy and distal subtotal gastrectomy) for T2N0M0 gastric cancer. Investigations showed an infiltrative tumor in the gastric stump, left-sided pleural effusion and suspected cancerous lymphangitis, multiple bone metastases, which were confirmed histologically. The patient suffered from oedema of the left leg, no other symptoms were present. The patient died on January 14, 2002 and autopsy was performed. Additionally to clinical findings, it revealed multiple metastases to retroperitoneal and pelvic soft tissues, the bladder and the prostate. The importance of this case report is due to unusual pattern of metastases of gastric stump cancer as well as the clinical manifestation of the disease. No typical symptoms and metastatic sites were seen. Little has been published regarding the pathways of the disease spread in patients with gastric remnant cancer and we did not find in the literature any reports of metastases to pelvic soft tissues, the bladder and the prostate. Conclusions: The patterns of the disease spread in gastric remnant cancer may differ from primary gastric cancer because of the previous surgical intervention. Patients after gastrectomy should be followed up even at long terms. Early diagnosis of the recurrence is the only possibility to cure the patient.

Keywords: gastric cancer, late recurrence, multiple metastases