A Rare Case of Recurrent Signet Ring Cell Carcinoma Presenting With Thrombocytopenia

DergiPark: 963059tmsjAims: Signet ring cell carcinoma is a rare type of gastric cancer most commonly seen in the stomach. There is a 60% systemic recurrence rate of gastric cancer after curative resection, and it most commonly recurs in the liver, peritoneum, and lungs. Bone metastasis is extremely rare in gastric cancer. We aim to present a rare case of signet ring cell carcinoma with thrombocytopenia as a primary symptom of bone marrow metastasis years after the patient’s primary diagnosis with gastric adenocarcinoma. Case Report: A 52-year-old male patient was admitted to the Medical Oncology Division of Trakya University Hospital with dyspeptic complaints six years ago, whereupon gastroscopy revealed an ulcerated lesion in the antral region of the stomach, and the pathological biopsy revealed adeno- carcinoma. The patient underwent subtotal gastrectomy and lymph node dissection, combined with adjuvant chemoradiotherapy. In the follow-up, a complete blood count revealed thrombocytopenia, and poorly differentiated adenocarcinoma metastasis with a signet ring cell component was demonstrated through imaging studies and pathological examination. Treatment with cisplatin and 5-fluorouracil was initiated after the diagnosis of human epidermal growth factor receptor-2 negative, stage 4 gastric adenocarcinoma. The patient showed clinical and laboratory response to the treatment and will continue with the current regimen. Conclusion: In this case, the primary tumor was in the stomach, and he had signs of thrombocytopenia only. When the prognosis of the patient was evaluated, it was thought that there was tumor residue at a cellular or clonal level in the stomach after gastrectomy, or an asymptomatic metastasis present and unnoticed in the bone marrow during the surgical treatment. In conclusion, this case shows that physicians should be alert to the changes in blood parameters in terms of recurrence with bone marrow involvement even if there is no visible recurrence in the patient