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.