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.