This report describes the successful treatment of a case of true gastric cancer presenting as protein-losing gastroenteropathy. A 58-year-old Japanese male presented gastric carcinoma. His serum albumin and total protein levels were 1.8 and 4.2 g/dl, respectively. He was diagnosed with gastric cancer with protein-losing gastroenteropathy based on (99m)Tc-human serum albumin scintigraphy. The patient underwent a total gastrectomy following neoadjuvant chemotherapy. There are 23 detailed case reports of gastric carcinoma with protein-losing gastroenteropathy. Most of these cases had large villous or cauliflower-like gastric tumors that were defined as papillary or well differentiated adenocarcinoma. Gastric cancer with protein-losing gastroenteropathy is extremely rare, but it can easily be diagnosed if the villous or cauliflower-like features are well defined.