Superscan Pattern as a Debut of Gastric Cancer

A 59-year-old male was admitted for generalized abdominal pain for a month, associated anemia, thrombocytopenia, and elevated alkaline phosphatase. An upper digestive endoscopy was performed, showing ulceration on the anterior face of the gastric body-antrum with characteristics of malignancy. A histopathology study of the biopsy sample revealed a high-grade poorly differentiated infiltrating tubular adenocarcinoma. Abdominal-enhanced CT images revealed multiple metastatic lesions in vertebral bodies and pelvic bones. Full body scintigraphy showed multifocal enhancement on the skeleton and absence of renal visualization (typical pattern of superscan), suggestive of bone metastatic spread [1,2]. Subsequently, a bone marrow aspiration of the sternum was performed, which confirmed metastatic infiltration of the bone marrow due to gastric neoplasia. Osteoblastic metastasis associated with gastric cancer is considered a relatively uncommon phenomenon [2].