Clinical Case Summary
Introduction: On a global scale, carcinoma of the stomach ranks within the four most common causes of oncological death in men, and within the fifth in women. Based on the level of tumor staging, there exist differing strategies for therapy.
The most well-known metastatic sites associated with gastric primary cancer are the peritoneum and the liver
Medullary invasion is generally discussed in the context of gastric lymphomas, while it is exceptionally rare in gastric adenocarcinoma. There are limited published data about gastric cancer with bone marrow involvement, its treatment and its prognosis, which remains unfavorable to date.
Objective of the study: The aim of this case report is to detail its clinical presentation, diagnostic workup, treatment approach, and outcomes to contribute to the understanding and management of this rare variant of gastric cancer.
Observation: A 43-year-old man with no medical history, presented to the emergency department with one-month history of a hemorrhagic syndrome characterized by melena, gingival bleeding, and retinal hemorrhage.
A biological assessment was performed upon admission, revealing normochromic normocytic anemia with hemoglobin levels at 3.4 g/dL and platelet count at 11,000/mm^3. Due to the lack of improvement in platelet count even after transfusion, an osteomedullary biopsy was performed for diagnostic purposes revealing a Spinal infiltration by a poorly differentiated and infiltrating gastric adenocarcinoma. After a platelet transfusion that brought the count up to 31000, we performed a fibroscopy to investigate the primary cause. This fibroscopy revealed a moderately differentiated and infiltrating adenocarcinoma with a signet ring component, ulcerated on the surface and the presence of neoplastic vascular emboli.
The case was discussed in a multidisciplinary consultation meeting, and the decision was made to start chemotherapy based initially on the LVFU5 protocol then the folfox protocol after a significant improvement.
Conclusion: Gastric cancer is known for its frequency, but the uniqueness of our patient lies in its rare medullary localization.
Gastric cancer can have an atypical presentation revealing its secondary localization.
Despite its poor prognosis, treatment can improve survival duration and quality of life in patients with medullary metastatic disease.
References
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