Abstract
RATIONALE: With the increasing survival rate of gastric cancer, more multiple primary cancers (MPC) have been reported. However, few cases involve metachronous multiple primary cancers which both occurred in the stomach. PATIENT CONCERNS: An 83-year-old Chinese male had been diagnosed with gastric cardia cancer and underwent proximal gastrectomy. The pathological result was gastric adenocarcinoma. 13 years later the patient's gastroscope result deteriorated. The biopsy of the antrum revealed dysplasia with doubtful focal cancerization. DIAGNOSES: Metachronous multiple primary cancers in the stomach. INTERVENTIONS: Endoscopic submucosal dissection (ESD) was performed. The pathological result showed an intra-mucosal signet-ring carcinoma. OUTCOMES: After treatment, the patient is alive with good condition until now. LESSONS: This is an unusual case of MPC with different pathological features in different parts of the same organ in an interval of more than ten years and undergoing different operations.