Shikata Hisaharu, Maruta Masaki, Kaneko Masahiko
Department of Internal Medicine, Uwajima City Hospital.
Rinsho Ketsueki. 2015 Jan;56(1):16-20. doi: 10.11406/rinketsu.56.16.
A 75-year-old man who had undergone subtotal gastrectomy for advanced gastric cancer 18 years previously with no signs of recurrence visited our hospital because of anemia detected by medical examination. Although no clinical abnormalities were evident, treatment with iron and vitamin B12 was started. However, because serum ALP was elevated, metastatic bone cancer was suspected. Subsequently, upper gastrointestinal endoscopy revealed findings suggestive of residual gastric cancer, and examination of a biopsy specimen demonstrated signet ring cell carcinoma. Furthermore, cells in a bone marrow biopsy sample showed morphology similar to that of cells obtained by stomach biopsy. FDG-PET demonstrated FDG accumulation only in the bone and residual stomach. The final diagnosis was bone metastasis from residual gastric cancer, and disseminated carcinomatosis of the bone marrow. Thereafter, pancytopenia progressed rapidly, and the patient died due to disseminated intravascular coagulation. When serum ALP is elevated in patients with a history of gastric cancer, bone marrow carcinomatosis should be suspected irrespective of symptoms, and imaging studies and bone marrow examination should be performed.
一名75岁男性，18年前因进展期胃癌接受了胃大部切除术，目前无复发迹象，因体检发现贫血前来我院就诊。尽管未发现明显临床异常，但仍开始给予铁剂和维生素B12治疗。然而，由于血清碱性磷酸酶（ALP）升高，怀疑发生了骨转移癌。随后，上消化道内镜检查发现提示残留胃癌的表现，活检标本检查证实为印戒细胞癌。此外，骨髓活检样本中的细胞形态与胃活检获得的细胞相似。氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示FDG仅在骨骼和残留胃中积聚。最终诊断为残留胃癌骨转移及骨髓播散性癌病。此后，全血细胞减少迅速进展，患者因弥散性血管内凝血死亡。对于有胃癌病史且血清ALP升高的患者，无论有无症状，均应怀疑骨髓癌病，并进行影像学检查和骨髓检查。
