Abstract
A 76-year-old man, diagnosed as to have 0-IIc type early gastric cancer located at the greater curvature of lower gastric body, was referred to our hospital. Biopsy of the tumor showed the presence of signet ring cell carcinoma. Infiltration to submucosa was revealed by endoscopic ultrasonography. No lymph node metastasis or distant metastasis was found by abdominal computed tomography (CT) scan. Although we planned elective gastrectomy for early gastric cancer (cT1bN0M0, Stage I A), the patient developed backache about 2 weeks after he was first seen and was subsequently diagnosed as to have multiple bone metastases by bone scintigraphy. Additional cervical CT scan identified a 10-mm enlarged lymph node in the left supraclavicular area. Biopsy of the node disclosed the presence of signet ring cells. Immunohistochemical examination of the node showed the positive staining for cytokeratin7 and cytokeratin20, but negative for napsin which was consistent with the immunohistochemical findings of the gastric primary lesion, suggesting the presence of Virchow's metastasis from the gastric primary. The patient died of disseminated intravascular coagulation (DIC) caused by disseminated carcinomatosis of the bone marrow 60 days after the initial referral.
We believe that this is the first case report of a patient demonstrating Virchow's metastasis combined with disseminated carcinomatosis of bone marrow from early gastric cancer.
