Aplastic Anemia Associated with Stomach

Hahn, Jee Sook; Kim, Doe Young; Nam, Dong Ki; Lee, Young Sik; Lee, Sun Ju; Ko, Yun Woong; Cho, Chang Hwan

Abstract

Herein is presented a case of aplastic anemia associated with adenocarcinoma of the stomach which seem- ed to be coincidental. A 52 year-old man was admitted with a 3 year history of dyspnea. Three years previously, he was diagnosed as bone marrow hypoplasia and had been treated with oxymetholone for 1 year. After confirmation of aplastic anemia during the first admission, he was followed up with fluoxymesterone and steriods. One year later, he was readmitted with melena. Fibergastroscopy and an UGl study revealed a fungating mass on the antrum suggestive of stomach cancer. Following perioperative platelet transfusions and intensive supportive care, a subtotal gastrectomy was performed and there were no postoperative complications. Pathologic examinations disclosed a moderately well differentiated adenocarcinoma. This is the first report in Korea of adenocarcinoma of the stomach occurring in a patient with aplastic anemia. He survived 17.5 months after the surgery and 5.4 years after the onset of aplastic anemia. Gastrointestinal bleeding in aplastic anemia may be incorrectly ascribed to steriod use and overlooked, thus the need to fully investigate gastric pathology by endoscopy as well as radiology is streesed. In a patient with pancytopenia, the major surgical procedures are frequently evaded by both surgeons and internists due to the possibility of morbidity from bleeding and infection. In this case, intensive perioperative supportive care and surgery were combined to prolong the patient's survival time.