title: A rare initial presentation of gastric cancer with multiple osteolytic lesions.
abstract: Gastric cancer is the 12th leading cause of cancer-related deaths in the United States and commonly metastasizes to the bones. However, the presentation of gastric cancer as bony metastases without preceding gastrointestinal symptoms is rare which has been infrequently reported in the literature. Moreover, leptomeningeal carcinomatosis is an unusual complication of gastric cancer accounting for less than 1 percent of these patients. We present a unique case of a middle aged male who presented to the emergency department with worsening backache which started one month priorly. The only abnormal laboratory test was an elevated alkaline phosphatase of 154 IU/L. The imaging of his spine showed osteolytic lesions which on biopsy revealed signet ring cells. A small 2 cm ulcerated mass was found on esophagogastroduodenoscopy at the gastric cardia which on biopsy revealed signet ring gastric carcinoma. The patient received chemotherapy with capecitabine and oxaliplatin as well as radiation and showed a good response initially. A few months later, he presented with persistent worsening headaches and on brain imaging was found to have leptomeningeal carcinomatosis. Ten months after the diagnosis of gastric carcinoma, he passed away.
authors.affiliation: Department of Internal Medicine, Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA.
authors.forename: Asad
authors.initials: A
authors.lastname: Jehangir
authors.affiliation: Department of Internal Medicine, Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Aderhold
authors.affiliation: Department of Internal Medicine, Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA.
authors.forename: Priya
authors.initials: P
authors.lastname: Rajagopalan
authors.affiliation: Department of Internal Medicine, Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA.
authors.forename: Oluwaseun
authors.initials: O
authors.lastname: Shogbesan
authors.affiliation: Department of Pathology, Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Swierczynski
authors.affiliation: King Edward Medical University, Mayo Hospital Road, Nelagumbad, Anarkali, Lahore 54000, Pakistan.
authors.forename: Anam
authors.initials: A
authors.lastname: Qureshi
authors.affiliation: Rawalpindi Medical College, Tipu Road, Rawalpindi 46000, Pakistan.
authors.forename: Qasim
authors.initials: Q
authors.lastname: Jehangir
authors.affiliation: Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Espana Schmidt