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Case Reports in Oncological Medicine
Volume 2015, Article ID 689431, 4 pages
Case Report

A Rare Initial Presentation of Gastric Cancer with Multiple Osteolytic Lesions

1Department of Internal Medicine, Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA
2Department of Pathology, Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA
3King Edward Medical University, Mayo Hospital Road, Nelagumbad, Anarkali, Lahore 54000, Pakistan
4Rawalpindi Medical College, Tipu Road, Rawalpindi 46000, Pakistan
5Reading Health System, Spruce Street/6th Avenue, West Reading, PA 19610, USA

Received 16 February 2015; Accepted 15 April 2015

Academic Editor: Se-Hoon Lee

Copyright © 2015 Asad Jehangir et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.