Superior mesenteric vein (SMV) thrombosis caused by acute appendicitis is

Introduction: Gastric malignancy remains a lethal disease, especially in developing countries. Advanced disease mostly involve peritoneum, liver, and lung. Bone involvement is rare, and bone marrow dissemination is even rarer. Hematological abnormalities may be seen as complications of gastric malignancy. Therefore knowledge of gastric malignancy possibilities spreading to bone marrow and causing hematological complications need to be taken. Case illustration:This case report describes a 33-year-old woman who complained of weakness, waxing and waning fever, leg pain, back pain, and weight loss. The patient examination revealed pallor, and the laboratory work-up depicted severe anemia and thrombocytopenia; the peripheral blood smear was consistent with leukoerythroblastosis. Bone marrow biopsy revealed adenocarcinomas. During hospitalization, the patient presented melena, and an upper digestive endoscopy showed an ulcerated and infiltrative lesion in antrum which the histopathology reported evidence of gastric adenocarcinoma. PET-CT scan showed multiple metastatic of lymph node in neck, chest, and abdomen. Liver and bone also showed diffuse metastases. Discussion:Our case highlights an unusual case of gastric adenocarcinoma with manifestations of bicytopenias and leukoerythroblastosis. As the diagnosis of gastric adenocarcinoma is based on endoscopic biopsy, the diagnosis can be difficult if the complaints is nonspecific, particularly in advanced stage. Diagnosis also become difficult in patients with bicytopenia and it is important to have a broad differential diagnosis when approaching a patient with bone pain. The aggressive behavior of this malignancy made poor outcome on patient.