A Case of Multiple Bone Metastases following Gastric Cancer Surgery who Survived for 3 Years an 10 Months after Diagnosis

Abstract

In this case report, we present a 71-year-old male who had undergone distal gastrectomy with D2 dissection for gastric cancer in February 2002. The pathological diagnosis was Type 0-IIa, tub2>tub1>Sig, pT1b (SM), INFγ, ly-1, v-0, pN2 (4/40), pPM0, pDM0, pStage IIA (Japanese Classification of Gastric Carcinoma [14^th Edition]). In May 2014, 12 years after his initial surgery, he revisited our hospital with high blood alkaline phosphatase (ALP) levels, which were observed during follow-up with a family doctor. He was diagnosed with multiple metastatic bone tumors on bone scintigraphy. Bone biopsy findings were suggestive of signet-ring cell carcinoma. With no obvious primary tumor, he was diagnosed with multiple bone metastases from gastric cancer. He continued receiving chemotherapy using S-1 and lived a normal life for three years. Three and a half years after starting treatment, he suddenly developed disseminated bone marrow carcinoma along with low back pain, and died a month later. To obtain a favorable long-term prognosis, it is important to diagnose and initiate treatment for bone metastases, which may occur even after long time after gastric cancer surgery, before symptoms appear. Therefore, continuously measuring ALP values is desirable.