A case of virchow's metastasis associated with disseminated carcinomatosis of bone marrow from early gastric cancer rapidly progressed to its termination before planned surgery

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  • GOTO Hironobu
    Department of Surgery, National Hospital Organization, Osaka National Hospital
  • FUJITANI Kazumasa
    Department of Surgery, National Hospital Organization, Osaka National Hospital
  • HIRAO Motohiro
    Department of Surgery, National Hospital Organization, Osaka National Hospital
  • IKENAGA Masakazu
    Department of Surgery, National Hospital Organization, Osaka National Hospital
  • TSUJINAKA Toshimasa
    Department of Surgery, National Hospital Organization, Osaka National Hospital

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  • 早期胃癌の手術待機中にVirchow転移，播種性骨髄癌症を認め急激な転帰をとった1例
  • 症例 早期胃癌の手術待機中にVirchow転移,播種性骨髄癌症を認め急激な転帰をとった1例
  • ショウレイ ソウキ イガン ノ シュジュツ タイキ チュウ ニ Virchow テンイ,ハシュセイ コツズイガンショウ オ ミトメ キュウゲキ ナ テンキ オ トッタ 1レイ

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A 76-year-old man, diagnosed as to have 0-IIc type early gastric cancer located at the greater curvature of lower gastric body, was referred to our hospital. Biopsy of the tumor showed the presence of signet ring cell carcinoma. Infiltration to submucosa was revealed by endoscopic ultrasonography. No lymph node metastasis or distant metastasis was found by abdominal computed tomography (CT) scan. Although we planned elective gastrectomy for early gastric cancer (cT1bN0M0, Stage I A), the patient developed backache about 2 weeks after he was first seen and was subsequently diagnosed as to have multiple bone metastases by bone scintigraphy. Additional cervical CT scan identified a 10-mm enlarged lymph node in the left supraclavicular area. Biopsy of the node disclosed the presence of signet ring cells. Immunohistochemical examination of the node showed the positive staining for cytokeratin7 and cytokeratin20, but negative for napsin which was consistent with the immunohistochemical findings of the gastric primary lesion, suggesting the presence of Virchow's metastasis from the gastric primary. The patient died of disseminated intravascular coagulation (DIC) caused by disseminated carcinomatosis of the bone marrow 60 days after the initial referral.<BR>We believe that this is the first case report of a patient demonstrating Virchow's metastasis combined with disseminated carcinomatosis of bone marrow from early gastric cancer.

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