Jin Chao-Bo, Li Yong-Sheng, Zhang Juan, Wu Jian, Tao Wei-Jing
Department of Nuclear Medicine, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu Province, China.
Department of Rheumatism and Immunology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu Province, China.
World J Gastrointest Oncol. 2025 Jun 15;17(6):106848. doi: 10.4251/wjgo.v17.i6.106848.
This report describes a rare case of a small gastric cancer lesion with widespread bone metastases and markedly elevated alkaline phosphatase levels that was initially misdiagnosed as rheumatoid arthritis, as the patient's sole clinical manifestation was chronic bone pain persisting for 1 year.
An 83-year-old man was admitted due to worsening generalized joint pain over 1 year. Serum alkaline phosphatase levels were markedly elevated, and technetium-99m methylene diphosphonate single-photon emission computed tomography (CT) and fluorine-18 sodium fluoride positron emission tomography (PET)/CT images showed symmetrical diffuse uptake of the radiotracers throughout the skeleton. Initially, Paget's disease was suspected, but abnormal hematologic tumor markers and bone biopsy confirmed metastatic adenocarcinoma. Fluorine-18-fluorodeoxyglucose PET/CT did not reveal a primary tumor. The patient had a history of colon polypectomy and tubulovillous adenoma with atypical hyperplasia on pathological examination 10 years prior. Further investigation using gallium-68-labeled fibroblast-activation protein inhibitor PET/CT images showed increased punctate uptake in the gastric antrum. Gastroscopy demonstrated a 1.0 cm ulcerated mass in the prepyloric region, and histopathological evaluation of the biopsy specimen revealed poorly differentiated adenocarcinoma. The incidence of bone metastases from gastric cancer is very low, especially with such extensive involvement.
Occult gastric carcinomas with bone metastases necessitate proactive high-risk surveillance and multidisciplinary integration to improve diagnostic accuracy and clinical outcomes.
本报告描述了一例罕见的小胃癌病灶伴广泛骨转移且碱性磷酸酶水平显著升高的病例，该病例最初被误诊为类风湿关节炎，因为患者唯一的临床表现是持续1年的慢性骨痛。
一名83岁男性因1年来全身关节疼痛加重入院。血清碱性磷酸酶水平显著升高，锝-99m亚甲基二膦酸盐单光子发射计算机断层扫描（CT）和氟-18氟化钠正电子发射断层扫描（PET）/CT图像显示放射性示踪剂在整个骨骼中呈对称性弥漫性摄取。最初怀疑为佩吉特病，但异常的血液学肿瘤标志物和骨活检证实为转移性腺癌。氟-18氟脱氧葡萄糖PET/CT未发现原发性肿瘤。患者有10年前结肠息肉切除术史，病理检查显示为管状绒毛状腺瘤伴非典型增生。使用镓-68标记的成纤维细胞激活蛋白抑制剂PET/CT图像进行进一步检查显示胃窦部点状摄取增加。胃镜检查显示幽门前区有一个1.0 cm的溃疡肿块，活检标本的组织病理学评估显示为低分化腺癌。胃癌骨转移的发生率非常低，尤其是如此广泛的累及。
隐匿性胃癌伴骨转移需要积极进行高危监测和多学科整合，以提高诊断准确性和临床结局。
