Successful chemotherapy of carcinomatosis of the bone marrow with disseminated intravascular coagulation from a rectal carcinoma found by eosinophilia

A 71-year-old man with eosinophilia was given a diagnosis of poorly differentiated adenocarcinoma of the rectum. Further examination showed that it had invaded the bone marrow. He had disseminated intravascular coagulation (DIC) from disseminated carcinomatosis of the bone marrow after colostomy. Chemotherapy (mFOLFOX6) was successful and his eosinophil count, DIC score and tumor markers normalized. We were able to continue chemotherapy after 5 months from the outbreak of disseminated carcinomatosis of the bone marrow. It is said that disseminated carcinomatosis of the bone marrow has a poor prognosis, but we were able to obtain a good response in this case by chemotherapy.     

Asymptomatic disseminated carcinomatosis of bone marrow presenting as hyperphosphatasia: report of a case

Metastatic involvement of the musculoskeletal system is one of the most significant clinical issues facing orthopaedic oncologists. The number of patients with metastasis to the skeletal system from a carcinoma is 15 times greater than the number of patients with primary bone tumours of all types. However, progression patterns like disseminated carcinomatosis of bone marrow are comparatively rare. The pathophysiology for disseminated carcinomatosis of bone marrow, with a prognosis reported to be very poor, is still unknown. We describe a patient who had no symptoms with hyperphosphatasia. Bone scintigraphy showed a so-called super bone scan and a needle biopsy from the ileum showed adenocarcinoma cells. Additional endoscopic investigation was performed and signet cell gastric cancer was found. From the bone scan and biopsy, we established the diagnosis of disseminated carcinomatosis of the bone marrow. From the experience of this case, we believe that intensive stomach investigation should be considered in cases with hyperphosphatasia, even when the patient has no symptoms.     

Disseminated carcinomatosis of the bone marrow originating from hepatocellular carcinoma. A case report

A 50‐year‐old male patient was admitted to the hospital for persistent high fever and back pain. He was diagnosed with hepatocellular carcinoma (HCC), bone marrow metastasis and disseminated intravascular coagulation (DIC). Despite the diagnosis and treatment, the general condition deteriorated rapidly and he died of cerebral hemorrhage associated with generalized bleeding tendency. Autopsy showed multiple HCC in the liver and systemic metastasis including bone marrow. The case describes a rare complication of HCC with disseminated carcinomatosis of the bone marrow (DCBM) complicated with DIC, with rapid deterioration and death. This is the first case of DCBM from HCC. Physicians need to be aware of DCBM in patients with HCC.     

Early Gastric Cancer as a Possible Cause of Cauda Equina Syndrome and Disseminated Intravascular Coagulation

Abstract: Early gastric cancer is an important gastric malignancy which is defined as adenocarcinoma confined to the mucosa or submucosa of the stomach with or without simultaneous metastases involving regional lymph nodes. The prognosis of early gastric cancer is generally good with a 5-year survival rate of about 95%. Distant metastases and disseminated intravascular coagulation (DIC) usually occur in the advanced stage of gastric cancer but are relatively rare in early gastric cancer. Cauda equina syndrome has never before been reported as the initial presentation of gastric cancer, and to our knowledge, up to 1993, only 17 cases of early gastric cancer with synchronous liver metastases had been reported. Bone metastases with DIC and adrenal metastasis are both rare in early gastric cancer. Herein, we present a case of early gastric cancer with an initial presentation including cauda equina syndrome and DIC. Synchronous hepatic, adrenal gland, pulmonary, bone and bone marrow metastases were found two days after admission. The patient had a fulminant clinical course and died 45 days after the diagnosis. A small focus (0.8 × 0.5cm) of poorly differentiated adenocarcinoma located in the mucosa and submucosa at the gastric lower body with extensive lymphatic permeation around the primary focus and duodenum were noted at autopsy. Cancers with an unknown primary accounted for 4.9% of cancers presenting with disseminated intravascular coagulation. Our experience disclosed that early gastric cancer is a potential cause of cauda equina syndrome and disseminated intravascular coagulation.     

Disseminated carcinomatosis of bone marrow from submucosal carcinoma in adenoma of the rectum.

A 62-year-old man was admitted because of paresis of the legs and a bleeding tendency. He was diagnosed as metastatic bone cancer with disseminated intravascular coagulation (DIC). In spite of treatment, his general condition progressively deteriorated and he died of respiratory failure 13 days later. Autopsy revealed a carcinoma in adenoma in the rectum. Although the depth of cancer invasion was confined to the submucosal layer, disseminated carcinomatosis of the bone marrow and tumor emboli in blood vessels of the lung were present.     

Recent aspects for disseminated carcinomatosis of the bone marrow associated with gastric cancer: What has been done for the past,and what will be needed in future?

Disseminated carcinomatosis of the bone marrow is characterized by widespread bone metastasis(bone marrow infiltration) from solid tumors with hematological disorders coexisted. This disease is frequently complicated with gastric cancer among solid tumors although its incidence is very rare. In recent years,technological innovations in diagnosis and treatment for cancer have remarkably improved,which made survival rates of various cancers prolonged. Prognosis of disseminated carcinomatosis of the bone marrow associated with gastric cancer,however,is still poor(less than a year),possibly because this disease has not been given attention due to low incidence. In this review,I summarize the results obtained for the past,and propose ways to improve the prognosis of this disease.     

A case of sclerosing cholangitis caused by oral chemotherapy with S-1

We report a case of sclerosing cholangitis caused by oral chemotherapy with S-1. A 79-year-old woman with a history of hypertension presented with epigastric discomfort. Upper gastrointestinal endoscopy revealed advanced gastric cancer in the gastric antrum and abdominal computed tomography showed multiple lymph node metastasis. The patient underwent chemotherapy with S-1. Since 2 months later, blood chemistry analysis showed liver dysfunction and hyperbilirubinemia, and chemotherapy was discontinued. Endoscopic retrograde cholangiopancreatography revealed stenosis of the bile duct at the hepatic hilum. There was no evidence of tumor in the liver. We diagnosed chemotherapy-induced sclerosing cholangitis (CISC) caused by S-1. Although treatment with ursodeoxycholic acid and corticosteroids was temporarily effective, she eventually died of CISC and gastric cancer. To the best of our knowledge, this is the first case report of CISC caused by S-1. We present this rare condition with a review of the literature.     

Disseminated Carcinomatosis of Bone Marrow as the Initial Presentation of Intrahepatic Cholangiocarcinoma without Jaundice: An Autopsy Case Report

Disseminated carcinomatosis of the bone marrow (DCBM) is often accompanied by disseminated intravascular coagulation (DIC) and has a poor prognosis. DCBM develops most frequently in gastric cancer and is rarely associated with intrahepatic cholangiocarcinoma. A 41-year-old man was incidentally found to have DIC on his regular visit for ulcerative colitis and was diagnosed with DCBM with intrahepatic cholangiocarcinoma. He received intensive care, including chemotherapy, but died suddenly from hyperkalemia, possibly due to tumor lysis syndrome (TLS). The autopsy showed the periductal infiltrating type of intrahepatic cholangiocarcinoma and tumor necrosis, possibly due to chemotherapy, indicating the effectiveness of chemotherapy for DCBM with intrahepatic cholangiocarcinoma.     

Successful initial treatment with weekly 24-hour infusion of 5-fluorouracil and leucovorin in a rectal cancer patient with acute disseminated intravascular coagulation

Cancer-associated acute disseminated intravascular coagulation is rare in colorectal cancer, but is rapidly fatal when present. We present a case of a 79-year-old male who developed acute disseminated intravascular coagulation one month after receiving Hartmann's procedure for his rectal cancer. Peripheral blood showed leucoerythroblastosis while marrow carcinomatosis was noted by bone marrow examination. Prompt chemotherapy with weekly 24-h infusion of 5-fluorouracil and leucovorin were administered and the acute disseminated intravascular coagulation gradually resolved after 2 cycles of treatment. A total of 10 cycles of weekly chemotherapy were administered. The patient died of pneumonia on the 83rd day after diagnosis of disseminated intravascular coagulation without evidence of acute disseminated intravascular coagulation and tumor progression. We suggest that if acute disseminated intravascular coagulation developed after surgery for rectal cancer, the cancer-related acute disseminated intravascular coagulation should be taken into consideration. The immediate administration of chemotherapy may save the patient in time.     

Gastric cancer associated with acute disseminated intravascular coagulation: successful initial treatment with weekly 24-hour infusion of high-dose 5-fluorouracil and leucovorin

Acute disseminated intravascular coagulation (DIC) is a severe complication of gastric adenocarcinoma, and most of the patients die within 1–3 weeks. We have treated five such patients with an empirical non- myelosuppressive HDFL regimen (weekly 24 h infusion of high-dose 5-fluorouracil 2600 mg/m² and leucovorin 300 mg/m²). Within 2 weeks of starting the treatment the clinical and laboratory evidence of acute DIC quickly resolved in all five patients. HDFL not only caused no further myelosuppression, but also resulted in normalization of the patient's haemogram within a few weeks. Other anti-cancer drugs could then be safely added. Three patients had a survival time of more than 6 months. We suggest that HDFL is an ideal initial treatment for gastric cancer complicated by acute DIC.     

Advanced gastric cancer associated with DIC successfully treated with 5-FU and cisplatin: a case report

We report a case of advanced gastric cancer complicated by disseminated intravascular coagulation successfully treated with chemotherapy consisting of 5-fluorouracil and cisplatin. The patient was a 53-year-old woman who complained of loss of appetite, weight loss, and low back pain. Based on the laboratory data, a diagnosis of disseminated intravascular coagulation was made. Gastroscopy revealed gastric carcinoma (Borrmann type 3) that was continuously bleeding, and chest computed tomography showed a solitary lung metastasis and bilateral pleural effusion. Bone scintigraphy revealed multiple bone metastases. Accordingly, we made a diagnosis of stage IV gastric cancer complicated by disseminated intravascular coagulation. We selected the 5-fluorouracil and cisplatin combination chemotherapy for treatment and obtained the patient's consent. After two cycles of the 5-fluorouracil and cisplatin therapy, the bleeding symptoms improved and the disseminated intravascular coagulation process was successfully controlled. We concluded that disseminated intravascular coagulation caused by gastric cancer may be improved when the primary cancer and its metastases are brought under control by treatment with FP combination chemotherapy.     

Long-term survival after gastrectomy and metastasectomy for gastric cancer with synchronous bone metastasis

Bone metastasis is a rare event in patients with gastric cancer, but pathologic fracture, paralysis, pain and hematological disorders associated with the bone metastasis may influence the quality of life. We report herein the case of a 53-year-old man who presented with primary remnant gastric cancer with bone metastasis. The patient requested further investigations after detection of a metastatic lesion in the 2 nd lumbar vertebra during evaluation for back pain that had persisted for 3 mo. No other metastatic lesions were detected. He underwent total gastrectomy and palliative metastasectomy to aid in reduction of symptoms, and he received combination chemotherapy with tegafur(S-1) and cisplatin. The patient survived for about 60 mo after surgery. Currently, there is no treatment guideline for gastric cancer with bone metastasis, and we believe that gastrectomy plus metastasectomy may be an effective therapeutic option for improving qualityof life and survival in patients with resectable primary gastric cancer and bone metastasis.     

Clinicopathologic features and clinical outcomes of gastric cancer that initially presents with disseminated intravascular coagulation: A retrospective study

Background and Aim: Few systematic studies have been published on prognosis and clinical outcome of gastric cancer patients with disseminated intravascular coagulation (DIC) as the first presentation of malignancy. We evaluated the clinicopathologic features and clinical outcomes of this population. Methods: We reviewed the medical records of patients with metastatic or recurred gastric cancer that initially presented with DIC. Results: Twenty‐one patients were included. Median age was 47 years (range, 24–72 years). Eighteen patients (85.7%) had bone metastasis, and nine patients (42.9%) had hemorrhagic complication of DIC. Fourteen patients received palliative chemotherapy, and seven patients received best supportive care (BSC). The most common factor influencing the decision to abandon the palliative chemotherapy was uncontrolled bleeding (57.1%). The median overall survival (OS) of all patients was 58 days (range, 2–342 days). The OS was significantly shorter in BSC than in the chemotherapy group (median, 16 vs 99 days, P < 0.001). In multivariate analysis, chemotherapy was independently associated with longer OS. In the chemotherapy group, the response to treatment was evaluable in 11 patients: two (18.2%) had a partial response, five (45.5%) had stable disease and four (36.4%) had progressive disease. The OS of patients with progressive disease was significantly longer in the chemotherapy group than in the BSC group (median, 92 vs 16 days, P = 0.009). Conclusions: The prognosis is poor with gastric cancer that initially presents with DIC but palliative chemotherapy, compared with BSC, prolongs OS. Therefore, early and intensive management for correctable DIC followed by chemotherapy should be considered in this population.     

An idiopathic skin eruption resembling a butterfly rash in a septic patient with disseminated intravascular coagulation following bone marrow transplantation.

A 31-year-old man who underwent chemotherapy and bone marrow transplantation to treat acute myeloblastic leukemia was admitted to our department complaining of high fever and hypotension. His physical examination revealed warm shock state, eruptions resembling that seen in systemic lupus erythematosus on his face and cyanosis in his fingers. We diagnosed septic shock and idiopathic skin eruption on his face. Following treatment with blood transfusion, anticoagulant, antibiotics, respirator and continuous arteriovenous hemofiltration and dialysis, the patient's condition gradually improved. The eruptions on his face first observed at admission progressed with a worsening of his disseminated intravascular coagulation (DIC), and subsided with an improvement in his DIC. A biopsy of the eruption was taken and pathological findings of the eruption revealed multiple micro-fibrin depositions of the dermis. The skin necrosis in purpura fulminans often begins in the distal extremities. But our patient developed this uncommon skin eruption on his face. Patients with an idiopathic skin eruption resembling a butterfly rash in a septic patient should be considered to complicate DIC as in the present case.     

Long-term response with low-dose of apatinib combined with S-1 in pretreated patient with advanced squamous cell lung cancer: A case report

Rationale:Squamous cell lung cancer is one of the major pathological types in patients with non-small cell lung cancer. Since treatment with angiogenic agents and target drugs in patients with advanced squamous cell lung cancer is not promising, there are limited strategies to improve the outcome in such patients. Herein, we report a pretreated patient with advanced squamous cell lung cancer, who received low-dose of apatinib combined with S-1 as salvage treatment, with good long-term response.Patient concerns:The patient complained of dry cough for one month without any relief by medication. Otherwise, she denied any other medical or family history.Diagnosis:According to the chest computed tomography, and pathologic findings from biopsy for lesion in lung, the patient was diagnosed with lung squamous cell lung cancer with enlargement of bilateral supraclavicular lymph nodes suggesting metastasis, staged as IIIb.Interventions:The patient received gemcitabine plus cisplatin as first line treatment, and gemcitabine as maintenance therapy. After progression, she received vinorelbine as second line treatment. After progression again, she received low-dose apatinib combined with S-1 as third line treatment.Outcomes:With the follow-up period from October 21, 2014, to April 6, 2019, there were 15 months, 9 months, and 24 months of progression-free survival time for first line (including maintenance therapy), second line, and third line treatment, respectively. The only adverse event was neutropenia at grade 2 (CTC AE) occurring during the maintenance treatment.Lessons:This case indicated that low-dose apatinib combined with S-1 might be effective and safe in selected pretreated patients with advanced squamous cell lung cancer. It might be worthy to conduct further researches to investigate the efficacy and safety of the combination therapy in such patients.     

Sequential chemotherapy with methotrexate and 5-fluorouracil for chemotherapy-naive advanced gastric cancer with disseminated intravascular coagulation at initial diagnosis

Purpose  

Advanced gastric cancer (AGC) rarely presents with disseminated intravascular coagulation (DIC) at the time of diagnosis before treatment with no current standard chemotherapy (CTx) regimen. However the prognosis is extremely poor without CTx. We investigated the effectiveness of sequential CTx with methotrexate and 5-fluorouracil (MF) in chemotherapy-naive AGC patients with DIC.     

Third-line chemotherapy with paclitaxel, irinotecan hydrochloride and cisplatin for recurrent gastric cancer: a case report

With the availability of new chemotherapeutic agents such as S-1 and paclitaxel (TXL) for advanced gastric cancer, the development of a strategy for a third-line chemotherapy is urgently needed. We treated a patient with recurrent gastric cancer using TXL, irinotecan hydrochloride (CPT-11) and cisplatin (CDDP) as a third-line chemotherapy. The patient was a 46-year-old man who had undergone total gastrectomy for advanced gastric cancer with lymph node metastases. For postoperative recurrence, he was first treated with S-1 as an outpatient; however, tumor markers increased, and para-aortic lymph node metastasis was revealed by thoracic and abdominal CT scan. A second-line therapy with weekly TXL and CDDP was then added, but resulted in PD. Therefore, combination chemotherapy with TXL, CPT-11 and CDDP was started biweekly as a third-line chemotherapy. TXL (80mg/m2) was infused over 1 hour after short premedication, followed by CPT-11 (25mg/m2) and CDDP (15mg/m2) over 30 min. After 6 courses of this therapy, the serum AFP and TPA returned to normal, and the size of the metastatic para-aortic lymph nodes reduced. The effect of this therapy was judged as PR and the toxicity of this regimen was tolerable. The patient has undergone 10 courses of this therapy and is maintaining a clinical PR. The patient was able to resume his full social activities. TXL, CPT-11 and CDDP combination chemotherapy may be useful and safe for patients with recurrent gastric cancer, even after first-or second-line therapy with S-1 or taxanes.     

替吉奥联合紫杉醇周疗对晚期老年胃癌患者的临床疗效评价

目的评价替吉奥(S-1)联合紫杉醇周疗治疗晚期老年胃癌患者的近期疗效及毒副反应物。方法将广西横县人民医院确诊的38例晚期老年胃癌患者随机分为2组,治疗组20例,采用紫杉醇联合替吉奥化疗:紫杉醇60 mg/m2,第1、8、15 d用药,替吉奥胶囊80 mg/m2,2次/d,连续口服14 d,28 d为1个周期;对照组18例,采用FP方案:顺铂15 mg/m2,第1~5天静点,5-Fu 750mg/m2,第1~5天静点,28 d为1个周期。两组患者至少治疗2个周期后评价其疗效及毒副反应。结果治疗组与对照组的有效率(RR)、疾病控制率(DCR)、1年生存率分别为40.0%、75.0%、55.0%和22.2%、50.0%、38.9%,差异无统计学意义(P0.05);治疗组患者KPS改善情况优于对照组(P0.05);治疗组的胃肠道反应及Ⅲ~Ⅳ度骨髓抑制明显低于对照组(P0.05)。结论替吉奥口服联合紫杉醇周疗方案化疗有效率高,老年患者耐受性好,是老年晚期胃癌患者值得选择的化疗方案。     

Rapid bone marrow dissemination of gastrointestinal lymphomas after surgical resection

We describe two cases of gastrointestinal lymphoma associated with rapid bone marrow dissemination after surgical resection. Case 1: A 73-year-old male was diagnosed as having malignant lymphoma originating from ileocaecal region (diffuse medium-sized, B cell type). Tumor (8 x 8 cm) was resected but infiltrated to the peritoneum and curative operation could not be done. Two weeks after operation, elevation of LDH, pancytopenia and bone marrow infiltration of lymphoma cells developed and he died of respiratory failure. Case 2: A 69-year-old female was diagnosed as having remnant gastric lymphoma (diffuse large, B cell type). Tumor size was 5 x 4 cm and swelling of the third lymph nodes was found, so curative operation could not be done. Two months after operation bone marrow infiltration of lymphoma cells was observed and she is now undergoing chemotherapy. Surgical resection is performed in the majority of patients with localized gastrointestinal lymphoma. But the operation of the advanced case must be carefully done, because the operative procedure may sometimes facilitate growth and metastasis of tumor.     

Ganglioneuroblastoma with disseminated bone marrow infiltration in an adult.

Ganglioneuroblastoma is an extremely rare neoplasm of adults. We present a case of adrenal ganglioneuroblastoma in a 47-year-old female with disseminated bone marrow involvement. Bone marrow involvement was the major manifestation which determined the mortality of this patient. This case suggests that the diagnosis of bone marrow involvement should be carefully considered even in adult-onset ganglioneuroblastoma.