Abstract
Bone metastasis is an uncommon event in advanced gastric cancer patients and bone metastases are rarely detected as isolated lesions. However, eleven years after treatment for locally advanced gastric cancer, including total gastrectomy followed by adjuvant chemotherapy, a 49-year-old female was admitted to the IX Division of General Surgery of the Second University of Naples (Naples, Italy) exhibiting severe progressive neurological symptoms. Magnetic resonance imaging indicated vertebral abnormalities, with evidence of marrow infiltration in several vertebral bodies; however, a contrast-enhanced computed tomography scan did not detect disease progression to other sites. Biopsy of the soft tissue at the level of the second lumbar vertebra (L2) revealed a metastatic lesion derived from gastric mucinous adenocarcinoma. The patient was initially treated with radiotherapy directed to the L2–L4 vertebral bodies to control the pain. Subsequently, systemic chemotherapy according to a FOLFOX-4 (leucovorin, fluorouracil and oxaliplatin) regimen commenced. However, after eight cycles, pulmonary progression of the disease occurred. Thus, palliative care was administered and the patient succumbed one month later. The late relapse of gastric cancer in the current patient may be associated with the theory of tumour dormancy.
Highlights
Gastric cancer (GC) is the fourth most common malignancy, and the third leading cause of cancer‐related mortality amongKey words: vertebral metastases, gastric cancer, tumour dormancyClincial history
GC usually metastasizes to the liver, peritoneum, lymph nodes and lungs, whereas bone metastases are uncommon, occurring in ~13.4% of autopsy cases in a Japanese study, and are rarely detected as isolated lesions [6,7,8,9,10]
The metastatic path of neoplastic GC cells is generally hematogenous through the bone marrow, as the gastric mucosa has a rich capillary network and the bone marrow does not contain lymphatic vessels [14]
Summary
Gastric cancer (GC) is the fourth most common malignancy, and the third leading cause of cancer‐related mortality among. A CT‐guided biopsy of the soft tissue at the L2 level revealed metastatic adenocarcinoma with signet ring cells; the biopsy cells positively stained for mucin, cytokeratins 7 and 20, and carcinoembryonic antigen, whereas the cells were negatively stained oestrogen and progesterone receptors, as well as cancer antigen (CA) 125. These histological features were consistent with metastasis from gastric mucinous adenocarcinoma.
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