Lab Med Online.  2021 Oct;11(4):305-310. 10.47429/lmo.2021.11.4.305.

Gastric Signet Ring Cell Carcinoma with Metastasis to the Bone and Bone Marrow in a Patient with 12-Year-Disease-Free Interval and Unusually Long Survival Time

• Kim HW
• Gu MJ
• Lee JH

• KMID: 2526093
• DOI: http://doi.org/10.47429/lmo.2021.11.4.305

Abstract

Gastric cancer (GC) is the second most common malignancy in Korea. Most deaths are due to disease recurrence; hence, efforts have been made to identify the recurrence patterns and establish a therapeutic strategy for GC. A 56-year-old man was diagnosed with signet ring cell carcinoma (SRCC) of the stomach 26 years ago, in December 1992. He had local recurrence in November 2006. The patient visited a hospital for back pain in April 2018. Laboratory tests, computed tomography (CT) scans, bone scan, bone and bone marrow biopsies, and bone marrow aspiration were conducted. Bone scan revealed hotspots indicating tracer uptake in the ribs, sternum, pelvic bones, and multiple vertebrae. Chest and abdominal CT scans revealed no lesion except diffuse osteosclerotic lesions of the bony thorax. Finally, bone marrow studies indicated metastatic SRCC. The patient survived for 26 months after treatment with four regimens of palliative chemotherapy. Each regimen was changed due to disease progression. He died due to pneumonia in June 2020. Metastasis to the bone and bone marrow in GC with a disease-free interval of more than 10 years is extremely rare. The patient had an unusually long survival time compared to that reported in previous studies, which have shown a median survival time of less than 3 months. To the best of our knowledge, in Korea, this is the first case of metastasis of gastric SRCC to the bone and bone marrow with a disease-free interval of more than 10 years.

Keyword

Bone; Bone marrow; Gastric cancer; Long-term disease-free survival; Metastasis; Signet ring cell carcinoma

Figure

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  Fig. 1 Bone scans showing hotspots in the ribs, sternum, pelvic bones, and multiple vertebrae.

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  Fig. 2 Bone marrow aspirate smear showing signet ring cells in a cluster (Wright’s stain, × 400).

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  Fig. 3 (A) Bone marrow biopsy showing metastatic signet ring cell carcinoma in the normal marrow space (arrowhead, hematoxylin and eosin stain, ×200). (B) Immunohistochemical staining of the bone marrow biopsy was positive for pan-cytokeratin antibody (pan-CK, ×200).

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  Fig. 4 Timeline of the patient’s diagnosis and treatment regimens.

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