Abstract
BACKGROUND: Adrenal metastasis from gastric cancer is rare and usually occurs as part of widespread systemic dissemination. Solitary adrenal metastasis detected during postoperative follow-up is extremely uncommon and easily overlooked due to nonspecific clinical manifestations. CASE PRESENTATION: We report the case of a 69-year-old man who underwent radical gastrectomy for esophagogastric junction cancer one year earlier. Histopathology revealed diffuse infiltrative mucinous adenocarcinoma with components of signet-ring cell carcinoma and neuroendocrine carcinoma (pT4N3Mx). The patient completed six cycles of adjuvant chemotherapy with tegafur-gimeracil-oteracil (S-1) plus oxaliplatin, and routine follow-up examinations showed no evidence of recurrence. Twenty-one months postoperatively, he presented with left upper abdominal pain. Computed tomography revealed a solitary mass in the left adrenal gland. Tumor markers, including CA72-4, CA19-9, and carcinoembryonic antigen, were markedly elevated. Ultrasound-guided biopsy confirmed metastatic adenocarcinoma of gastric origin. The patient was treated with SOX chemotherapy combined with the PD-1 inhibitor tislelizumab. After the first treatment cycle, his general condition improved, and he remains under close follow-up. CONCLUSION: This case highlights the importance of vigilance for rare metastatic sites, such as the adrenal gland, in patients with advanced gastric cancer even after standardized postoperative surveillance. Systemic chemotherapy combined with immunotherapy may represent an effective treatment strategy for selected patients with metastatic gastric cancer.