title: Bone marrow infiltration as the initial presentation of gastric signet ring cell adenocarcinoma.
abstract: This case report describes a 52-year-old African American man who initially presented with worsening back pain. The patient was found to have lytic lucencies in the T5 and T9 vertebral bodies and a subsequent bone marrow biopsy revealed an extensive infiltrate of signet ring cells. These findings prompted a workup for a gastrointestinal malignancy, and upper endoscopy revealed a mass in the gastric pylorus. A biopsy of this mass was positive for signet ring cell adenocarcinoma. This case is significant for two reasons. First, it highlights the importance of a broad differential diagnosis when approaching a patient with lytic bone lesions. Second, bone marrow involvement is more common in patients with diffuse type gastric cancer and occurs in particularly young patients. The increasing incidence of diffuse type gastric adenocarcinoma means bone marrow metastases will likely play a greater role in the presentation and management of gastric cancer.
authors.affiliation: 1 Hematology-Oncology Department, Boston Medical Center, 820 Harrison Avenue, FGH Building, 1st Floor, Boston, MA 02118, USA ; 2 Internal Medicine Department, Boston Medical Center, 72 East Concord Street, Evans 124 Boston, MA 02118, USA ; 3 Pathology Department, Boston Medical Center, 670 Albany Street, Boston, MA 02118, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Dittus
authors.affiliation: 1 Hematology-Oncology Department, Boston Medical Center, 820 Harrison Avenue, FGH Building, 1st Floor, Boston, MA 02118, USA ; 2 Internal Medicine Department, Boston Medical Center, 72 East Concord Street, Evans 124 Boston, MA 02118, USA ; 3 Pathology Department, Boston Medical Center, 670 Albany Street, Boston, MA 02118, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Mathew
authors.affiliation: 1 Hematology-Oncology Department, Boston Medical Center, 820 Harrison Avenue, FGH Building, 1st Floor, Boston, MA 02118, USA ; 2 Internal Medicine Department, Boston Medical Center, 72 East Concord Street, Evans 124 Boston, MA 02118, USA ; 3 Pathology Department, Boston Medical Center, 670 Albany Street, Boston, MA 02118, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Malek
authors.affiliation: 1 Hematology-Oncology Department, Boston Medical Center, 820 Harrison Avenue, FGH Building, 1st Floor, Boston, MA 02118, USA ; 2 Internal Medicine Department, Boston Medical Center, 72 East Concord Street, Evans 124 Boston, MA 02118, USA ; 3 Pathology Department, Boston Medical Center, 670 Albany Street, Boston, MA 02118, USA.
authors.forename: Andreea
authors.initials: A
authors.lastname: Negroiu
keywords: Bone marrow infiltration; bone marrow metastasis; diffuse type; gastric cancer; lytic bone metastasis; signet ring cell; stomach cancer