Recurrent gastric cancer metastasizing to the bone marrow: A case report of a rare presentation

INTRODUCTION Gastric cancer notoriously recurs post curative surgical resection. While there may be visceral metastasis to peritoneal surfaces, bone marrow involvement may also occur although with rarity. We present a case report of recurrent gastric cancer with bone marrow metastasis in a patient with no evidence of systemic disease on follow-up for two years post surgical resection. This case demonstrates the need of heightened clinical suspicion in these patients. METHODS We reviewed the medical records of a patient who presented with metastatic gastric adenocarcinoma to the bone marrow two years post R0 subtotal gastrectomy with Roux-en-Y gastrojejunostomy without evidence of systemic disease on follow up for two years. RESULTS Laboratory and imaging studies of the patient on presentation two years post R0 subtotal gastrectomy with Roux-en-Y gastrojejunostomy is as follows; elevated alkaline phosphatase (ALP) of 472 U/L, CT chest/abdomen/pelvis that showed multiple new sclerotic lesions throughout osseous structures suspicious for metastasis, PET/CT that showed many sclerotic lesions throughout the axial and appendicular skeleton, some FDG-avid and suspicious for active osseous metastasis. Bone marrow biopsy showed metastatic poorly differentiated carcinoma consisted with known history of gastric cancer. CONCLUSION Gastric cancer has a high rate of recurrence post curative surgery. Despite the rarity of bone marrow metastasis, a high level of suspicion should be maintained in patients presenting with elevated ALP and evidence of pancytopenia post curative surgery.