Mieloptisis y cáncer gástrico: Una asociación infrecuente / Myelophthisis and gastric cancer. An unusual association

Se denomina mieloptisis a la infiltración de la médula ósea por células no hematopoyéticas. En pacientes con cáncer gástrico esta invasión es extremadamente infrecuente y la supervivencia suele ser menor a tres meses. Presentamos el caso de un hombre de 35 años con compromiso de la médula ósea secundario a un carcinoma gástrico difuso de células en anillo de sello.

The infiltration of the bone marrow y non-hematopoietic cells is called myelophthisis. In patients with gastric cancer, this invasion is extremely infrequent and the survival is usually less than three months. We present the case of a 35-year-old man with bone marrow involvement secondary to diffuse gastric carcinoma of signet ring cells.

Bicytopenia and leukoerythroblastosis: a rare initial presentation of signet ring cell gastric adenocarcinoma

Gastric adenocarcinoma is a common neoplasia and is responsible for up to 30% of the overall deaths due to cancer. Advanced disease is mostly characterized by peritoneum, liver, and lung involvement. The spread of the disease to the bone is rare, and bone marrow dissemination is even rarer. In this setting, leukoerythroblastosis may be the initial manifestation of the disease. The authors report the case of a 64-year-old Caucasian man who sought medical care complaining of back pain, weakness, and weight loss. The physical examination revealed pallor, and the laboratory work-up depicted severe anemia and thrombocytopenia; the peripheral blood smear was consistent with leukoerythroblastosis. The ongoing investigation through a bone marrow biopsy showed massive involvement of the bone marrow by a signet ring cell adenocarcinoma. During hospitalization, the patient presented melena, and an upper digestive endoscopy depicted an ulcerated and infiltrative lesion in the cardia, upon which the histological examination revealed a signet ring cell adenocarcinoma. This case highlights the bone marrow invasion represented by bicytopenia and leukoerythroblastosis as the initial manifestation of this histological type of gastric cancer. Although treatment attempts were made with chemotherapy and radiotherapy, the patient died early on, showing the aggressive behavior of this form of tumoral presentation.

Mielopatia por deficiência de cobre / Cupper deficiency myelopathy

A deficiência de cobre (CU) adquirida ganha reconhecimento como causa de anemia e neutropenia. Na última década, ela é reconhecida como produtora de mielopatia ou mieloneuropatia degenerativa, que mimetiza a deficiência de vitamina de B12, podendo apresentar-se em concomitância com essa última. Foram discutidos etiologias, fisiopatologia, diagnósticos diferenciais e tratamentos, assim como achados radiológicos caraterísticos na ressonância nuclear magnética (RNM), principalmente na imagem ponderada T2, da medula cervical e dorsal, confrontando-as com dados laboratoriais direcionados à patologia, conseguindo-se maior acurácia diagnóstica. Observou-se que o diagnóstico precoce pode reverter a doença do ponto de vista laboratorial, de imagem e neurológico ou estabilizar a progressão. Sendo assim, recomendamos incluir na pesquisa laboratorial das cirurgias bariátricas, gastrectomias, síndromes de má-absorção e na administração oral de zinco (Zn)...

Acquired copper (Cu) deficiency has been recognized to promote anemia and neutropenia. During the last decade degenerative myelopathy or myeloneuropathy diseases that can be mimicked by vitamin B12 deficiency or in another cases both of them (Cu and B12 deficiency) can coexist. We researched etiologies, physiopathology, differential diagnostic, treatment and radiologic findings in MRI, that showed high T2 signal in posterior cervical and thoracic cord and when assembled with laboratorial data we achieved accurate diagnostics. We observed that precocious diagnostic could revert the disease and improve neurologic deficit or stabilize its progression. However, we recommend laboratorial research in bariatric surgery, gastrectomy, malabsortion syndromes and high zinc levels administration...