Sun W, Chen XC, Wang H, Chang WY, He Y, Lin ZH, Jia H, Zhang XM, Liu H. Bone marrow metastasis of gastric signet ring cell carcinoma complicated by thrombotic microangiopathy: A case report. World J Gastrointest Oncol 2025; 17(8): 109424 [DOI: 10.4251/wjgo.v17.i8.109424]
Corresponding Author of This Article
Hong Liu, MD, PhD, Chief Physician, Professor, Department of Hematology, Affiliated Hospital of Nantong University, No. 688 Qingnian East Road, Nantong 226001, Jiangsu Province, China. hongliu63@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Aug 15, 2025; 17(8): 109424 Published online Aug 15, 2025. doi: 10.4251/wjgo.v17.i8.109424
Bone marrow metastasis of gastric signet ring cell carcinoma complicated by thrombotic microangiopathy: A case report
Wei Sun, Xiao-Ci Chen, Han Wang, Wei-Yu Chang, Yun He, Zeng-Hua Lin, Hui Jia, Xiao-Mei Zhang, Hong Liu
Wei Sun, Wei-Yu Chang, Yun He, Xiao-Mei Zhang, Department of Oncology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu 215500, Jiangsu Province, China
Wei Sun, Hong Liu, Department of Hematology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
Xiao-Ci Chen, Department of Oncology, Changshu Hospital Affiliated to Soochow University, Changshu No. 1 People’s Hospital, Changshu 215500, Jiangsu Province, China
Han Wang, Zeng-Hua Lin, Hui Jia, Department of Oncology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
Author contributions: Sun W, Chen XC, Wang H and Chang WY designed the research; He Y, Lin ZH, Zhang XM performed the research; Liu H contributed new reagents/analytic tools; Chen XC and Wang H analyzed the data; Sun W wrote the paper.
Supported by the Research Project for Clinical Research on Precision Diagnosis and Innovative Treatment of Bone Marrow Failure, No. 2024YFC2510500; Jiangsu Provincial Traditional Chinese Medicine Science and Technology Development Plan, No. YB2020102; and Nantong Municipal Health Commission Research Project, No. QN2023007.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong Liu, MD, PhD, Chief Physician, Professor, Department of Hematology, Affiliated Hospital of Nantong University, No. 688 Qingnian East Road, Nantong 226001, Jiangsu Province, China. hongliu63@126.com
Received: May 12, 2025 Revised: June 7, 2025 Accepted: July 11, 2025 Published online: August 15, 2025 Processing time: 95 Days and 18.2 Hours
Abstract
BACKGROUND
Thrombotic microangiopathy (TMA) is an acute syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and multi-organ dysfunction due to the microcirculation of platelet thrombi. Cancer-associated TMA is a rare and fatal complication, which often occurs during cancer remission. It is frequently misdiagnosed because of limited clinical awareness.
CASE SUMMARY
A middle-aged female patient presented to our clinic with a 15-days history of back pain, 15 months post-gastrectomy. Cancer-associated TMA was confirmed through bone marrow aspiration, biopsy, and imaging. The patient received intermittent transfusions, fluids, nutrition, and microcirculation therapy with partial coagulation improvement. The family refused intensive care unit admission and plasma exchange, preferring palliative care. The patient died of cerebral hemorrhage and herniation due to disease progression. This case indicates that TMA may serve as an early manifestation of various malignancies, particularly gastric cancer. However, it is often misdiagnosed. Its pathogenesis is not well understood and needs to be further investigated. Currently, no standardized treatment have been developed. Plasma exchange is the only intervention available, though other therapies may also be effective.
CONCLUSION
In this case of gastric signet-ring cell carcinoma complicated by TMA, the patient achieved transient remission with supportive care but died following treatment discontinuation. Further studies are needed to elucidate the pathological mechanisms and therapeutic strategies for cancer-associated TMA.
Core Tip: Thrombotic microangiopathy (TMA), characterized by microangiopathic hemolytic anemia and multi-organ failure, is a rare and underrecognized complication of malignancies. This report highlights a fatal case of gastric signet-ring cell carcinoma with bone marrow metastasis and TMA, diagnosed 15 months post-gastrectomy. TMA may precede cancer recurrence and is frequently misdiagnosed due to overlapping symptoms. Supportive therapies achieved transient remission, but discontinuation led to fatal progression. Currently, the disease is managed through plasma exchange, but evidence supporting efficacy of this treatment is lacking. This case demonstrates that TMA may be a potential early marker of aggressive malignancies and emphasizes the urgent need to clarify its pathogenesis and optimize treatment strategies for cancer-associated TMA.
