A Case of Early Gastric Cancer with Systemic Bone Metastasis 12 Years after Resection

Abstract

A 68-year-old man underwent distal gastrectomy and D2 dissection for early gastric cancer in 2004. It was histopathologically diagnosed as T1b (SM), N2 (7, # 4d, 5, 6, 8a), ly0, v0, stage II, according to the Japanese Classification of Gastric carcinoma, 13th edition. Twelve years later, he visited a local doctor because of back pain and was referred to our hospital due to an increased serum alkaline phosphatase. Computed tomography (CT) showed osteogenic changes in the spine and pelvic bone, and FDG-positron emission tomography (PET) showed high FDG accumulation in the bones. Biopsy from the spine showed adenocarcinoma that was considered metastasis of gastric cancer because its histology was similar to that of the resected gastric cancer, positive for human gastric mucin and negative for prostate-specific antigen. Early gastric cancer can recur to bone more than 10 years after resection.