Abstract
A 50-year-old man with mild mental retardation consulted a local physician 5 days after developing dyspnea, and he was referred to our hospital for further evaluation due to severe anemia. His vital signs were stable and normal. On physical examination, no abnormalities were detected other than pale conjunctiva. The complete blood cell count and chemistry showed severe anemia, accelerated bone metabolism, and disseminated intravascular coagulation (DIC). Computed tomography (CT) showed diffuse osteosclerotic metastasis, without any obvious primary tumor in the neck, chest, abdomen, or pelvis. Although erosive changes were observed in the angle of the stomach, upper and lower endoscopies could not identify a source of bleeding responsible for severe anemia and there was no evidence of a malignant disease. In addition, gallium scintigraphy showed diffuse bone accumulation, and thus extensive bone metastasis of malignancy was considered likely. On day 8 of admission, he developed an intracranial hemorrhage, resulting in unconsciousness and death.
On postmortem examination, there was 0-IIa+IIc-like invasive gastric cancer in the angle of the stomach. Myeloid cells in the bone marrow were almost completely replaced with adenocarcinoma cells, which were the same as the gastric cancer cells on immunohistochemical staining. Therefore, a diagnosis of disseminated carcinomatosis of bone marrow (DCBM) due to gastric cancer was made. DCBM can cause DIC and microangiopathic hemolytic anemia and has a poor prognosis. The primary lesion is gastric cancer in most cases of DCBM. DCBM should be considered the top differential diagnosis in cases with clinically diagnosed DIC with diffuse osteosclerosis on CT. Radiologists should alert the other clinicians to the possibility of gastric cancer, which is often the primary lesion responsible for DCBM.
