Vertebral carcinomatosis eleven years after advanced gastric cancer resection: A case report

Abstract

Bone metastasis is an uncommon event in advanced gastric cancer patients and bone metastases are rarely detected as isolated lesions. However, eleven years after treatment for locally advanced gastric cancer, including total gastrectomy followed by adjuvant chemotherapy, a 49-year-old female was admitted to the IX Division of General Surgery of the Second University of Naples (Naples, Italy) exhibiting severe progressive neurological symptoms. Magnetic resonance imaging indicated vertebral abnormalities, with evidence of marrow infiltration in several vertebral bodies; however, a contrast-enhanced computed tomography scan did not detect disease progression to other sites. Biopsy of the soft tissue at the level of the second lumbar vertebra (L2) revealed a metastatic lesion derived from gastric mucinous adenocarcinoma. The patient was initially treated with radiotherapy directed to the L2–L4 vertebral bodies to control the pain. Subsequently, systemic chemotherapy according to a FOLFOX-4 (leucovorin, fluorouracil and oxaliplatin) regimen commenced. However, after eight cycles, pulmonary progression of the disease occurred. Thus, palliative care was administered and the patient succumbed one month later. The late relapse of gastric cancer in the current patient may be associated with the theory of tumour dormancy.

Bone Metastases from Gastric Cancer: What We Know and How to Deal with Them

“…Lastly, even if the majority of the GC recurrence occur into the first two years after curative resection, anecdotal cases of late relapses have been reported in the literature [ 72 , 73 ]. In particular, Iovino et al reported the case of a 49-year-old patient who showed a tumor relapse from GC after 11 years from the curative surgical resection [ 73 ].…”

“…Lastly, even if the majority of the GC recurrence occur into the first two years after curative resection, anecdotal cases of late relapses have been reported in the literature [ 72 , 73 ]. In particular, Iovino et al reported the case of a 49-year-old patient who showed a tumor relapse from GC after 11 years from the curative surgical resection [ 73 ]. The patient had severe neurological signs from a diffuse vertebral involvement and marrow infiltration without detection of any other metastatic lesions or primary tumor; the biopsy of the soft tissue near the lumbar vertebra confirmed the metastatic nature of the lesion, which spread from GC.…”