Infiltrating gastric adenocarcinoma with disseminated osteoblastic metastases

Abstract

We report the case of a man with a diagnosis of invasive gastric adenocarcinoma associated with scattered osteoblastic metastases. This 65-year-old patient was admitted with nausea, vomiting and abdominal pain, in addition to loss of weight (13 Kg in 3 months). Upper digestive endoscopy revealed extensive infiltrating changes in the body of the stomach, and histopathologic data confirmed the diagnosis of a Borrmann IV gastric adenocarcinoma. Complementary exams were indicative of a gastric cancer with bone metastases, characterized by disseminated osteoblastic images of the scintigraphy of the skeleton. Palliative chemotherapy was the treatment of first choice. High serum levels of CA 19-9, CEA and alkaline phosphatase can constitute useful indicative tools of this challenging condition. Images from a scintigraphy study of the skeleton can characterize the type and extension of bone metastases. The aim of this case study is to report a case of a very uncommon condition, considering that disseminated osteoblastic metastases rarely develop in this kind of tumor.Key words. Adenocarcinoma. Bone metastasis. Gastric tumor. RESUMENPresentamos un caso de adenocarcinoma gástri-co infiltrante asociado con metástasis osteoblásticas diseminadas. Un paciente de 65 años ingresó con náu-seas, vómitos y dolor abdominal asociados con pérdida de peso (13 Kg en 3 meses). La endoscopia digestiva objetivó extensas alteraciones infiltrativas del cuerpo gástrico y los datos histopatológicos confirmaron el diagnóstico de adenocarcinoma gástrico Borrmann IV. Exámenes complementarios fueran indicativos de cán-cer gástrico con metástasis óseas, caracterizadas por imágenes osteoblásticas diseminadas de la cintilografía del esqueleto. Se le administró quimioterapia paliativa como primera opción. Se elevó CA 19-9, CEA y apareció fosfatasis alcalina en el suero un indicador útil del diagnóstico. La extensión y el tipo de metástasis óseas pueden ser imágenes de cintilografías del esqueleto. Este caso tiene como objetivo describir la presencia de metástasis osteoblásticas diseminadas que raramente son producidas por este tipo de tumor.Palabras clave. Adenocarcinoma. Metástasis óseas. Tumor gástrico.

Metastatic Gastrointestinal Adenocarcinoma with Osteoblastic Activity: A Case Report of Esophageal and Colonic Primaries

“…The only gastrointestinal carcinomas documented to develop metastases with osteoblastic activity are from the stomach and occur very rarely. Breast and prostate carcinomas are typically seen to develop metastases that are osteoblastic in nature [ 2 , 3 ]. Other much less common sites of origin to develop osteoblastic metastases include lung, kidney, and thyroid carcinomas [ 2 – 5 ].…”

“…Breast and prostate carcinomas are typically seen to develop metastases that are osteoblastic in nature [ 2 , 3 ]. Other much less common sites of origin to develop osteoblastic metastases include lung, kidney, and thyroid carcinomas [ 2 – 5 ]. One paper reported pancreas as an originating site for osteoblastic metastases [ 6 ].…”

“…One paper reported pancreas as an originating site for osteoblastic metastases [ 6 ]. Gastric adenocarcinoma with osteoblastic metastases has only been reported in a handful of case reports [ 2 – 5 ].…”

“…Metastatic adenocarcinoma with osteoblastic activity is classically seen with breast, prostate, and lung carcinomas and less commonly with renal, thyroid, and gastric carcinomas [ 1 ]. Despite gastric carcinomas being the most common gastrointestinal malignancy to metastasize with osteoblastic activity, primary gastric carcinoma is a very rare occurrence [ 1 , 2 ]. Metastatic adenocarcinoma of esophageal or colonic primary has not been described in the literature to produce extraskeletal metastases with osteoblastic bone formation.…”