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Indian Journal of Medical and Paediatric Oncology
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IMAGES IN ONCOLOGY
Year : 2016  |  Volume : 37  |  Issue : 1  |  Page : 67  

Isolated bone marrow carcinomatosis: A rare presentation of poorly differentiated adenocarcinoma of the stomach in a young male


1 Department of Medicine, Dr. Sampurnanand Medical College, Jodhpur - 342 001, Rajasthan, India
2 Department of Pathology, Rudraksh Histopath Lab, Jodhpur - 342 001, Rajasthan, India

Date of Web Publication19-Feb-2016

Correspondence Address:
Hans Raj Pahadiya
Department of Medicine, Dr. Sampurnanand Medical College, Jodhpur - 342 001, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5851.177040

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How to cite this article:
Lakhotia M, Pahadiya HR, Gandhi R, Choudhary A, Purohit RC, Choudhary S. Isolated bone marrow carcinomatosis: A rare presentation of poorly differentiated adenocarcinoma of the stomach in a young male. Indian J Med Paediatr Oncol 2016;37:67

How to cite this URL:
Lakhotia M, Pahadiya HR, Gandhi R, Choudhary A, Purohit RC, Choudhary S. Isolated bone marrow carcinomatosis: A rare presentation of poorly differentiated adenocarcinoma of the stomach in a young male. Indian J Med Paediatr Oncol [serial online] 2016 [cited 2019 May 21];37:67. Available from: http://www.ijmpo.org/text.asp?2016/37/1/67/177040

A 30-year-old man came with complaints of generalized body pain, fatigability, dyspepsia, anorexia, weight loss, and exertional breathlessness for 6 months with no history of chronic illness, addiction or blood loss from any site in body. His vitals were stable. The conjunctiva was pale. Lymph nodes were not enlarged. Hemogram showed bicytopenia with hemoglobin of 4.2 g/dL, leukocytes 15,500/mm 3 and platelets of 62,000/mm 3 . The peripheral blood film showed leukoerythroblastic picture. The bone marrow biopsy revealed infiltration with malignant cells [Figure 1]a, and b. Gastroscopy showed an ulcerated hypertrophic mass lesion along the greater curvature of the stomach (3 cm × 3 cm). Histology of the gastric tissue showed poorly differentiated adenocarcinoma of the stomach, which stained positive for pan-cytokeratin applied with immunohistochemistry [Figure 1]c and d. The liver was normal on contrast enhanced computerized tomography. The serum alkaline phosphatase (ALP) value was 220 IU/L, serum lactate dehydrogenase (LDH), 250 IU/L, and serum calcium was 9.2 mg/dL. The liver and renal function tests, serum carcinoembryonic antigen, carbohydrate antigen-19-9, and coagulation profile was within normal limit. He tested negative for HIV, hepatitis B virus, hepatitis C virus, and coombs test. The chest X-ray, electrocardiogram, colonoscopy, digital X-ray of spine and echocardiogram were normal. He expired after 50 days of admission on supportive treatment in the form of blood product transfusion.
Figure 1: (a) Bone marrow biopsy showing infi ltration of malignant cells on ×10; (b): On ×40; (c): Histopathological examination of the gastric tissue showed poorly differentiated adenocarcinoma of the stomach on ×20; (d): These cells stained positive for pan-cytokeratin applied with immunehistochemistry on ×20

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The solid malignancies which commonly metastasise to bone marrow are breast, prostate, and rarely gastric cancer. The patients with bone marrow metastasis of gastric cancer are often younger and present with refractory anemia, cytopenias, elevated ALP, LDH, osteolytic lesions, and lower incidence of hypercalcemia with poorly differentiated adenocarcinoma being most common type. To conclude, case presenting with leukoerythroblastic picture on peripheral blood film, should be evaluated for the infiltrative pathology of the bone marrow. Isolated bone marrow carcinomatosis of poorly differentiated gastric adenocarcinoma in a young male is rare and associated with poor prognosis.

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