A case of bone marrow carcinomatosis from breast cancer treated with weekly Paclitaxel

We report a case of bone marrow carcinomatosis originating from breast cancer that was treated with weekly paclitaxel (PTX). A 42-year-old female patient underwent mastectomy with axillary lymph node dissection for breast cancer in 2001. Multiple bone metastases were diagnosed in 2008, but she remained stable with chemotherapy and hormonal therapy for about two years. In 2010, thrombocytopenia occurred, and she was diagnosed with bone marrow carcinomatosis after bone marrow biopsy. She was treated with weekly PTX(80 mg/m2), and recovered successfully after treatment. About one year has elapsed since initiation of therapy, and there has been no recurrence. Bone marrow carcinomatosis originating from breast cancer is very rare, and is regarded as a disease with a poor prognosis. However, weekly PTX could be a valid treatment for prolonging survival of bone marrow carcinomatosis originating from breast cancer.     

Characteristic features of disseminated carcinomatosis of the bone marrow due to gastric cancer: the pathogenesis of bone destruction

Disseminated carcinimatosis of the bone marrow is accompanied by solid tumors, and gastric cancer accounts for the majority. The prognosis of this condition is poor, however, the pathogenesis for wide-spread bone lesions has yet to be elucidated. In 9 patients with gastric cancer demonstrating disseminated carcinomatosis of the bone marrow, the characteristic clinicopathological features were examined. Immunohistochemistry for receptor activator of NF-kappaB ligand (RANKL) and parathyroid hormone-related protein was also performed on gastric cancer tissue and bone marrow specimens to identify the factors responsible for the occurrence of bone lesions in patients presenting with this condition. The characteristic features of disseminated carcinomatosis of the bone marrow due to gastric cancer include a yonger patient age, an elevation of serum alkaline phosphatase and/or lactate dehydrogenase levels, wide-spread bone metastases with osteolytic bone destruction, a low incidence of hypercalcemia and a histological gastric cancer type of either signet ring cell carcinoma or poorly diffentiated adenocarcinoma. The expression of RANKL, which is one of the master regulators of osteoclastic bone resorption in bone metastasis, was also found in gastric cancer cells obtained from such patients. The RANKL expressed in gastric cancer may therefore play a critical role in the promotion of osteoclast formation, which has been suggested to be involved in the pathogenesis of bone lesions.     

Effectiveness and safe use of modified FOLFOX-6 for metastatic gastric cancer with signet ring cell components complicated by disseminated intravascular coagulation and diffuse bone marrow carcinomatosis

We report the case of a 62-year-old woman with a metastatic gastric cancer complicated by diffuse bone marrow carcinomatosis, disseminated intravascular coagulation (DIC) and microangiopathic hemolytic anemia (MHA) treated by modified FOLFOX-6 as front-line chemotherapy regimen. This chemotherapy showed clinical, morphological and biological efficiency and safety in this rare and severe hematological complication at initial diagnosis. Furthermore, this is the first case of diffuse bone carcinomatosis from a gastric cancer to be monitored by positron emission tomography integrated computed tomography (PET-CT) scan using 18-fluorodeoxyglucose (18-FDG).     

Two cases of advanced gastric cancer with diffuse carcinomatosis of the bone marrow showing a widespread osteoplastic bone metastasis

Reported are 2 cases of an advanced gastric cancer with a "diffuse carcinomatosis of the bone marrow" (DCMB) showing a widespread osteoplastic bone metastasis. In a DCBM, a widespread invasion of cancer cells to the bone marrow occurs, causing leukoerythroblastosis, anemia, and disseminated intravascular coagulation. The local reaction in the bone, namely being osteoplastic or osteolytic, has not been discussed in previous papers. Our cases were characterized by an extremely high serum alkaline phosphatase, a "superscan" view of the bone scintigram, and a diffuse osteoplastic bone metastasis with an osteoid increase. Thus we think there are DCBM subtypes with a diffuse osteoplastic bone metastasis.     

A Case of Bone Marrow Recurrence from Gastric Carcinoma after a Nine-year Disease-free Interval

We present a case of very late and unusual recurrence of gastriccancer. Nine years following total gastrectomy for gastric carcinoma,a 57-year-old man presented with disseminated intravascularcoagulation associated with bone marrow recurrence. The primarytumor was a signet ring cell carcinoma invading the subserosallayer with lymph node metastasis. The patient was treated withsequential administration of methotrexate and 5-fluorouraciland went into remission. After treatment, he survived 10 months.Autopsy revealed diffuse bone marrow infiltration and distantlymph node metastasis with signet ring carcinoma cells.     

Two patients of progressive gastric cancer accompanied by disseminated carcinomatosis of bone marrow due to bone metastasis with DIC successfully controlled by combination of S-1 and CDDP

We performed chemotherapy with combination of S-1 and CDDP for two patients with progressive gastric cancer accompanied by disseminated carcinomatosis of bone marrow due to bone metastasis with DIC, which was successfully controlled, and they had about one-year prognosis. We think it is worth trying the chemotherapy for the patients with such a severe condition like DIC.     

A case of disseminated carcinomatosis of bone marrow treated by S-1 and cisplatin after distal gastrectomy for early gastric cancer

Patients with bone metastasis originating from gastric cancer experience complications from DIC. They are treated with anticoagulation therapy or platelet transfusion, but their prognosis is poor. Our case was a 50-year-old male who had undergone distal gastrectomy for early gastric cancer[pT1a(M)N0M0, pStage I a]ten years previously. He was admitted to our hospital complaining of backache. As a result of his examination, he was diagnosed with disseminated carcinosis of bone marrow with DIC as a postoperative recurrence of gastric cancer. The patient was treated with combination chemotherapy of S-1 and cisplatin(S-1 80 mg/body, po, day 1-21 and cisplatin 50mg/body, iv, day 8). After one course of treatment, DIC was resolved and his pain was relieved. He survived for about nine months. S-1 and cisplatin are considered to be effective for disseminated carcinosis of bone marrow.     

Bone marrow necrosis in a patient with metastatic breast cancer in chemotherapy with chlorambucil, methotrexate and prednisone

In this case report the clinical course of a female patient with metastatic breast cancer receiving a mild cytostatic regimen with chlorambucil, methotrexate and prednisone is described. She developed an unusual clinico-pathological syndrome with pancytopenia, fever and bone pain resulting from a bone marrow necrosis. The clinical course illustrates the great diagnostic difficulties and the potential benefit from rapid identification of this prognostically very poor event. Leading symptoms such as fever, bone pain, pancytopenia, an increase in the sedimentation rate, in lactate dehydrogenase and alkaline phosphatase in serum are often misinterpretated as tumor progression with bone or hepatic metastases and bone marrow carcinomatosis. An iliac crest aspirate and biopsy detects the diagnosis of a marrow necrosis. These symptoms should be kept in mind in order to avoid a diagnostic pitfall resulting from a misinterpretation of the morphological picture as necrotic metastasis in bone marrow or as an artefact. It is assumed that, in addition to the underlying malignant disease, cytostatic therapy with chlorambucil, methotrexate and prednisone triggers this event.     

A case of advanced gastric cancer with lymphangitis carcinomatosa after operation of Krukenberg tumor treated by TS-1 plus CPT-11 as third-line chemotherapy

Chemotherapies for recurrent gastric cancer have not yet been established. Here we report a case of type 4 gastric cancer associated with lymphangitis carcinomatosis which became refractory to the previous chemotherapies. The case was a 40-year-old woman. She had been diagnosed with gastric cancer after a Krukenberg tumor operation. Chemotherapies (TS-1 plus CDDP as first-line, and TS-1 plus taxanes as second-line) were performed, and a partial response was achieved. Disease activity has been well controlled until this time. Since recurrence of left pleural effusion and lymphangitis carcinomatosis was recognized, we changed the chemotherapy TS-1 plus CPT-11. Pleural effusion decreased and lymphangitis carcinomatosis improved. The serum CA 19-9 level rose transiently after CPT-11 administration, and tended to fall at the second week of chemotherapy. However, the patient died 2 years 4 months after the onset. TS-1 plus CPT-11 combination chemotherapy would be effective for lymphangitis carcinomatosis and also useful as third-line chemotherapy for recurrent gastric cancer.     

An autopsy case of maxillary cancer representing carcinomatosis of the bone

A 51-year-old man was admitted to our Otorhinolaryngological Clinic on November 18, 1980, complaining of a nasal blockage. A biopsy specimen from the left maxillary sinus resulted in a diagnosis of poorly differentiated squamous cell carcinoma. About a year after left maxillectomy, he presented with widespread skeletal metastasis and severe anemia. On August 25, 1982, he died of pneumonia. On autopsy, generalized bone metastasis was found; there was no local recurrence and only minimal pulmonary metastasis. Although there are some maxillary cancer cases with restricted bone metastasis, diffuse carcinomatosis of the bone, as seen in this case, is rare. We also present a review of similar cases.     

胃癌根治术后早期复发转移的危险因素分析

背景与目的：目前胃癌仍是癌症死亡的重要原因,其术后复发是导致胃癌患者生存率较低的主要因素。本研究旨在探讨胃癌患者术后早期、晚期复发转移与临床病理学特征的关系,以便更好地改善胃癌预后。方法：回顾性分析2014年1月—2016年1月在浙江省肿瘤医院行胃癌根治性手术后出现复发转移的188例胃癌患者的临床病理学资料,比较早期复发转移患者（≤2年）与晚期复发转移患者（>2年）的临床病理学特征的差异。结果：188例患者中,126例患者出现早期复发,62例患者出现晚期复发,总体中位复发时间为术后18个月。复发部位、淋巴结转移、浆膜浸润、无术前新辅助化疗、无术后辅助化疗及低分化是胃癌术后早期复发的独立危险因素。结论：复发部位、术前新辅助化疗、术后辅助化疗、淋巴结转移、浸润深度及组织分化程度与术后复发有关。     

Gastric Cancer with Bone Marrow Invasion and Disseminated Intravascular Coagulation: A Case Report

Gastric cancer is the fifth most commonly diagnosed cancer and the fourth leading cause of cancer death worldwide in 2020. Gastric cancer usually undergoes lymph node metastasis and implantation metastasis, but bone metastasis and bone marrow invasion are rare. However, gastric cancer patients with bone marrow invasion usually have cancer emergency, so special attention should be paid in clinical practice. Herein, we analyzed the clinical characteristics of an asian gastric cancer patient with bone marrow invasion and disseminated intravascular coagulation (DIC) in our hospital and summarized the diagnosis and treatment experience to provide a reference for such diseases.     

Gastric cancer recognized by metastasis to the ureter

Although ureteral obstruction is rarely noted in patients with gastric cancer at an advanced stage or at autopsy, the condition caused by authentic ureteral metastasis of gastric cancer is extremely rare. We experienced a case of gastric cancer in a 51-year-old woman who showed bilateral ureteral metastasis. The patient initially complained of right flank pain, caused by right ureteral obstruction, and was referred to our hospital, where she underwent a right nephroureterectomy, with suspicion of primary ureteral neoplasm. Histopathological examination of the resected specimen showed that metastatic growth of adenocarcinoma in the ureteral wall had caused the obstruction, and the subsequent extensive search for the primary lesion revealed asymptomatic gastric cancer. Soon after the nephroureterectomy, the patient developed left hydronephrosis, possibly caused by left ureteral metastasis, and a left percutaneous nephrostomy was performed. She then received chemotherapeutic reagents. However, she finally developed peritoneal carcinomatosis, and died of the disease about 1 year after the onset of the disease. In this report, we also review true ureteral metastasis from the stomach, and discuss the clinicopathologic features. Received: March 28, 2000 / Accepted: May 19, 2000     

Early (mucosal) gastric cancer with synchronous osteosclerotic bone metastases: a case report

ANAGNOSTOPOULOS G., SAKORAFAS G.H., KOSTOPOULOS P., MARGANTINIS G., TSIAKOS S. & PAVLAKIS G. (2010) European Journal of Cancer Care
Early (mucosal) gastric cancer with synchronous osteosclerotic bone metastases: a case report Early gastric cancer (EGC) is defined as an adenocarcinoma confined to the gastric mucosa or submucosa, regardless of the presence of lymph node metastases. Early gastric cancer carries an excellent prognosis, with a 5‐year survival rate at least 85% in most series. However, there are rare cases where distant metastases exist. Bone metastases are rare in gastric cancer; osteoblastic bone metastases are even rarer. We report a patient with EGC (mucosal) and synchronous osteosclerotic bone metastasis. To our knowledge, this is the first reported case of submucosal EGC with synchronous bone metastases. The patient was operated and he received adjuvant chemotherapy and radiotherapy. He died 18 months after gastric surgery from generalized disease.     

Microangiopathic hemolytic anemia associated with gastric cancer

A case of advanced gastric cancer associated with metastatic carcinomatosis of the bone marrow, microangiopathic hemolytic anemia (MAHA) and disseminated intravascular coagulation (DIC) was reported. A 71-year-old woman complained of lumbago and general fatigue. At the time of admission, besides anemia, jaundice and a tendency to bleeding, the laboratory data showed, hyperbilirubinemia, elevated FDP and hemolytic anemia with fragmented red cells. The bone marrow was infiltrated by carcinoma, and an upper GI series examination showed Borrmann II type gastric cancer on the greater curvature of the antrum. After remission of both MAHA and DIC by mitomycin C, neothramycin and FOY, the patient successfully underwent subtotal gastrectomy. However, she died of cerebral hemorrhage on the 96th postoperative day.     

Microangiopathic hemolytic anemia associated with advanced gastric cancer

Progressive, severe anemia developed in a 66-year-old man with advanced gastric cancer. A total gastrectomy was performed, after a rapid blood transfusion, to stop possible bleeding from cancer. There was no blood accumulation in the resected stomach. Laboratory data showed remarkable hemolysis and disseminated intravascular coagulation after the operation. A peripheral blood smear showed leukoerythroblastosis, which is indicative of bone marrow metastasis. Intensive therapy failed to control hemolysis and disseminated intravascular coagulation. On the 17th postoperative day, the patient suffered sudden respiratory arrest and subsequently died, possibly of a cerebrovascular accident. This is a rare case of microangiopathic hemolytic anemia associated with metastasis of gastric cancer to the bone marrow. Operative procedures should not considered for the patient with microangiopathic hemolytic anemia caused by cancer metastasis, because they offer no advantages for the patient's prognosis. Evaluation of causes of anemia can be helpful in managing patients with cancer.     

Bone marrow niches in the regulation of bone metastasis

The bone marrow has been widely recognised to host a unique microenvironment that facilitates tumour colonisation. Bone metastasis frequently occurs in the late stages of malignant diseases such as breast, prostate and lung cancers. The biology of bone metastasis is determined by tumour-cell-intrinsic traits as well as their interaction with the microenvironment. The bone marrow is a dynamic organ in which various stages of haematopoiesis, osteogenesis, osteolysis and different kinds of immune response are precisely regulated. These different cellular components constitute specialised tissue microenvironments—niches—that play critical roles in controlling tumour cell colonisation, including initial seeding, dormancy and outgrowth. In this review, we will dissect the dynamic nature of the interactions between tumour cells and bone niches. By targeting certain steps of tumour progression and crosstalk with the bone niches, the development of potential therapeutic approaches for the clinical treatment of bone metastasis might be feasible.Subject terms: Bone metastases, Metastasis     

Isolated Peritoneal Metastasis of Prostate Cancer Presenting with Massive Ascites: A Case Report

The peritoneal carcinomatosis of prostate cancer without bone or other visceral organ involvement is extremely rare. We report a case of an isolated peritoneal metastasis of prostate cancer in a patient without other metastatic sites and a history of prostate surgery. A 63-year-old male with locally advanced prostate cancer without known distant metastasis on androgen deprivation therapy presented with abdominal distension that had persisted for a month. Abdominopelvic computed tomography (CT) showed gastric wall thickening and a moderate amount of ascites. The gastroscopy showed hyperemic mucosal patches on the antrum body. A cytological examination of the ascites fluid was negative for malignant cells. Diagnostic laparoscopy showed multiple nodules in the peritoneum. A biopsy was performed. Histological findings were compatible with metastatic carcinoma of the prostate, which was immunohistochemically positive for pan-cytokeratin, the androgen receptor, and prostate-specific antigen (PSA). The patient was then treated with abiraterone acetate. After 1 month of treatment, both ascites and the PSA value decreased. We describe an extremely rare case of isolated peritoneal carcinomatosis from prostate cancer without any organ metastasis or history of surgery. Clinicians should be aware of these very rare metastases of prostate cancer. Hormonal therapy may be helpful for such cases.     

A Report of Disseminated Carcinomatosis of the Bone Marrow Originating from Transverse Colon Cancer Successfully Treated with Chemotherapy Using XELOX plus Bevacizumab

A 61-year-old male, who had been admitted to another hospital due to disseminated intravascular coagulation (DIC), was referred to our hospital. Total colonoscopy, abdominal dynamic CT and positron-emission tomography revealed bone metastasis and multiple lymphocytic metastases from transverse colon cancer in addition to disseminated carcinomatosis of the bone marrow (DCBM). We immediately performed chemotherapy with XELOX + bevacizumab and denosumab against DCBM from transverse colon cancer in order to avoid radical surgery. In addition, we initiated the administration of recombinant human soluble thrombomodulin for 1 week to treat DIC. The patient was able to tolerate and receive 4 cycles of chemotherapy without any severe side effects. After receiving the 4 cycles of treatment, he recovered from DIC, and the bone and multiple lymphocytic metastases disappeared.Key words: Disseminated carcinomatosis of bone marrow, Chemotherapy, Transverse colon cancer, Disseminated intravascular coagulation     

胃癌骨髓转移3例临床分析并文献复习

目的:探讨胃癌骨髓转移的临床特点、诊治方法及预后。方法:报告3例胃癌骨髓转移病例,分析其诊断治疗经过并复习相关文献。结果:3例患者确诊前均被误诊,确诊主要靠骨髓涂片和胃镜组织病理活检。3例中2例接受联合化疗,症状缓解,生存期延长。1例未治,2个月后死亡。结论:胃癌骨髓转移发病率低易误诊且预后差,联合化疗能缓解症状,延长生存期。