Aggressive case of early onset gastric cancer; identifying the knowledge gap.

A woman aged 30 years was referred for endoscopy for iron deficiency anaemia. Colonoscopy was normal. Upper endoscopy demonstrated multiple small, carpet-like, sessile polyps in the gastric fundus and a larger 4 cm polyp in the body (figure 1). The duodenum was normal without polyps. Endoscopic ultrasound demonstrated a 35×36 mm hypoechoic polypoid lesion arising from the mucosa and invading into the submucosa, but with well-defined borders suggesting lack of invasion into adjacent structures. Endoscopic mucosal resection was performed on a portion of this polyp for histology. Pathology showed a focus of high-grade dysplasia arising in hyperplastic polyp. Her mother and maternal grandmother had gastric cancer, and her sister had gastric polyps and a non-melanoma skin cancer. The patient underwent a laparoscopic total gastrectomy and surgical pathology demonstrated a poorly differentiated adenocarcinoma with 23 negative lymph nodes, stage pT1bN0M0 (figure 2). No adjuvant therapy was recommended, and surveillance CT scan at …