Case presentation
A 77-year-old man presented to our hospital with a six-month history of anorexia and weight loss. Past medical history included arterial essential hypertension. Previous surgeries included a left inguinal hernia. He had a tobacco smoking history of 30 pack years. No malignancies were noted in familial history. He denied abdominal pain, nausea, vomiting, hematochezia or melena. Physical examination revealed no abnormalities. No cervical lymphadenopathy or hepatosplenomegaly was objectified. Right arm was mildly swollen and tender to palpation but neurological examination was normal. Biological investigations showed Hb of 7,4 g/dl, WBC count 12 940/mm3, hyperneutrophilia of 10 010/mm3, platelets 502 000 /mm3 , C-reactive protein 10 mg/L. Renal profile and electrolyte level were normal. Serum calcium level and alkaline phosphatases were also within normal ranges. Serum level of carcinoembryonic antigen (CEA) was normal (11.3 ng/ml). Radiographs showed a pathologic fracture on a lytic lesion in his right humerus suggestive of bone metastasis (figure 1).
A computed scan was performed and objectified another lytic lesion in the eleventh right rib. (figure 2) A neoplastic origin was first suspected, confirmed by the presence on CT scan of a bulky gastric mass. (figure 3).
An upper endoscopy confirmed these findings by showing a fragile gastric mass in the level of the antrum sized 4 cm in greatest diameter. Biopsies taken from the stomach concluded to a well differentiated gastric adenocarcinoma.
An intramedullary nailing of the right humerus was proposed by orthopaedic surgeons, followed by systemic chemotherapy. Unfortunately, the patient lost to follow-up.