MANEC, a subtype of MiNEN, is a rare disease, even rarer when found in the remnant stomach. We report a residual gastric MANEC case found 44 years after subtotal gastrectomy. The patient was an 80-year-old female who underwent subtotal gastrectomy at 36 years old and was referred to our hospital for anorexia and weight loss. An elevated lesion(tub2> tub1)was found on the oral side of the anastomosis. Endoscopic submucosal dissection(ESD)was performed, which revealed MANEC with SM or deeper, ly1, HM?, and VM1, prompting referral for additional surgical resection. Completion remnant gastrectomy was performed. Pathological results showed 2 metastases in the left cardia lymph node and no residual cancer in the remnant stomach. The patient had a recurrence 9 months later and died 11 months after surgery. This case corresponds to not only MiNEN but also MANEC, and only 2 cases of remnant stomach MANEC(MiNEN)could be retrieved in PubMed. MANEC(MiNEN)is considered to have a poor prognosis. In this case, left cardia lymph node metastasis prompted a splenectomy, aiming to improve curability. However, the death of the patient 11 months post-surgery suggested that the disease displayed high malignant potential. Considering the high invasiveness of MANEC, lymphadenectomy and multidisciplinary treatment strategies should be considered. However, careful examination is necessary to see if they contribute to the prognosis.