Rare gastrointestinal associated pathology in systemic mastocytosis – gastric cancer in a patient with long history of mastocytosis. Case report and short literature review

Mastocytosis is a rare disease, resulting from infiltration of atypical mast cells in multiple organ and systems, pre­sen­ting with a variety of symptoms. Gastric cancer with gas­tro­in­tes­ti­nal symptomatology associated with systemic mas­to­cy­to­sis has been very rarely reported.We describe the case of a 49-year-old patient, with a long history of mas­to­cy­to­sis (cutaneous mastocytosis diagnosed from 2008, progressed to aggressive systemic mastocytosis in 2017), admitted in our clinic in 2020 with episodes of severe epi­gas­tric pain, emesis and a significant weight loss of 10 kg over the last month. The investigations revealed gastric ade­no­car­ci­no­ma. Despite the multidisciplinary approach (he­ma­to­lo­gist, oncologist, allergologist, gastroenterologist and general surgeon), the patient did not respond to on­co­lo­gi­cal chemotherapy. The peculiarity of this case lies in the as­so­cia­tion of mastocytosis with an oncological condition, where the accumulation of mast cells plays an important role in promoting angiogenesis and tumor invasion. The di­ges­tive symptoms specific to mastocytosis may have de­ter­mined a delay in the oncological diagnosis. This case em­pha­sizes the importance of multidisciplinary approach in the case of a hematological patient and of close mo­ni­to­ri­za­tion of the disease clinical course.