Jehangir Asad, Aderhold Kim, Rajagopalan Priya, Shogbesan Oluwaseun, Swierczynski Sharon, Qureshi Anam, Jehangir Qasim, Espana Schmidt Christian
Department of Internal Medicine, Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA.
Department of Pathology, Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA.
Case Rep Oncol Med. 2015;2015:689431. doi: 10.1155/2015/689431. Epub 2015 Apr 23.
Gastric cancer is the 12th leading cause of cancer-related deaths in the United States and commonly metastasizes to the bones. However, the presentation of gastric cancer as bony metastases without preceding gastrointestinal symptoms is rare which has been infrequently reported in the literature. Moreover, leptomeningeal carcinomatosis is an unusual complication of gastric cancer accounting for less than 1 percent of these patients. We present a unique case of a middle aged male who presented to the emergency department with worsening backache which started one month priorly. The only abnormal laboratory test was an elevated alkaline phosphatase of 154 IU/L. The imaging of his spine showed osteolytic lesions which on biopsy revealed signet ring cells. A small 2 cm ulcerated mass was found on esophagogastroduodenoscopy at the gastric cardia which on biopsy revealed signet ring gastric carcinoma. The patient received chemotherapy with capecitabine and oxaliplatin as well as radiation and showed a good response initially. A few months later, he presented with persistent worsening headaches and on brain imaging was found to have leptomeningeal carcinomatosis. Ten months after the diagnosis of gastric carcinoma, he passed away.
在美国，胃癌是癌症相关死亡的第12大主要原因，且常转移至骨骼。然而，胃癌以骨转移为首发表现且无先前胃肠道症状的情况较为罕见，文献中鲜有报道。此外，柔脑膜癌病是胃癌的一种罕见并发症，在这些患者中占比不到1%。我们报告了一例独特病例，一名中年男性因背痛加重就诊于急诊科，背痛始于一个月前。唯一异常的实验室检查是碱性磷酸酶升高至154 IU/L。其脊柱影像学检查显示溶骨性病变，活检显示印戒细胞。食管胃十二指肠镜检查在胃贲门处发现一个2 cm的小溃疡肿物，活检显示为印戒细胞型胃癌。该患者接受了卡培他滨和奥沙利铂化疗以及放疗，最初显示出良好反应。几个月后，他出现持续性头痛加重，脑部影像学检查发现有柔脑膜癌病。胃癌诊断十个月后，他去世了。
