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Case Reports
. 2016 Mar 16:1:6.
doi: 10.21037/tgh.2016.03.09. eCollection 2016.

Disseminated gastric carcinoma in disguise-presentation as microangiopathic haemolytic anemia with bone marrow necrosis

Jyotsna Yesodharan  1 , Shalini Kuruvilla  1 , Kanjirakkad Parameswaran Kavitha  1 , Madhavan Lilly  1
Affiliations
Case Reports

Disseminated gastric carcinoma in disguise-presentation as microangiopathic haemolytic anemia with bone marrow necrosis

Jyotsna Yesodharan et al. Transl Gastroenterol Hepatol. .

Abstract

Cancer related microangiopathic hemolytic anemia (MAHA) and bone marrow necrosis (BMN) are two rare and distinct clinicopathological entities reported in patients with disseminated malignancy. When they emerge as initial findings in a previously undetected case of malignancy, the diagnosis is often missed resulting in inappropriate management. We report the extremely rare association of cancer related MAHA and BMN as the first presentation of unsuspected disseminated gastric carcinoma in a 63 years old male. Early institution of chemotherapy is the only effective option for both these conditions, though with little improvement in outcome. This emphasises the need for increased awareness of such presentations in advanced malignancies.

Keywords: Gastric carcinoma; bone marrow necrosis (BMN); microangiopathic hemolytic anemia (MAHA).

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Peripheral smear showing schistocytes, spherocytes, polychromatophilic cells and normoblasts with thrombocytopenia (Leishman stain, 400×).
Figure 2
Figure 2
Bone marrow biopsy showing extensive necrosis (Haematoxylin & Eosin, 100×).
Figure 3
Figure 3
Gastric tissue showing poorly differentiated adenocarcinoma with signet ring cells (Haematoxylin & Eosin, 100×).
Figure 4
Figure 4
Perigastric lymph node showing adenocarcinomatous deposits (Haematoxylin & Eosin, 100×).
Figure 5
Figure 5
Three phase bone scan showing disseminated skeletal metastases.
See this image and copyright information in PMC

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