S6477 Spinal Cord Stenosis as the First Manifestation of Metastatic Gastric Adenocarcinoma in a Young Patient

Introduction: Gastric cancer is one of the most frequent causes of cancer-related death, of which gastric adenocarcinoma is the predominant type. Signet cell subset embodies 35%-45% of gastric adenocarcinoma and is typically found in advanced stages in young women. Advanced gastric signet cell carcinoma is associated with lower survival rates. Metastatic lesions typically occur in the liver, lymph nodes, peritoneum, and lung, with bone being a rarely detected site of metastasis. In this case, we report a rare case of gastric signet cell carcinoma with metastatic lesions extending to multiple skeletal structures including the spinal vertebrae, resulting in an initial presentation of spinal cord compression. Case Description/Methods: The patient is a 32-year-old man with no known past medical history presented with fever, tachycardia, elevated alkaline phosphatase, and worsening bilateral lower extremity radiculopathic pain for 2 months. Pain started after lifting a heavy box and was associated with numbness over the gluteal area. Magnetic resonance imaging (MRI) revealed extensive metastatic lesions, predominantly involving the lumbosacral spine resulting in severe spinal canal stenosis. Patient underwent T12-L1 laminectomy with pathology consistent with signet ring cell type metastatic adenocarcinoma. Computed tomography (CT) scan showed heterogeneous enhancement thickening in the gastric wall with nearby lymphadenopathy and osseous disease in the thoracolumbar spine. Esophagogastroduodenoscopy (EGD) revealed a large tumor in the gastric body and biopsy showed signet ring cell carcinoma. Immunostain results were positive for CK7 and negative for CK20, CDX2, and SATB2. Discussion: Metastatic spinal cord compression (MSCC) is a critical oncologic emergency resulting from tumor invasion of the vertebral column, leading to spinal cord or cauda equina compression. The present case is particularly uncommon, as it presents with MSCC as the initial manifestation of gastric cancer. This case highlights the aggressive nature of signet ring cell carcinoma, which often remains undetected until it has metastasized. Prompt diagnosis and treatment of MSCC are essential to alleviate pain and prevent irreversible neurological damage. MRI of the entire spine is recommended for diagnosis, and treatment typically includes glucocorticoid therapy, pain management, radiation with or without surgery, and specialized rehabilitation. Given the aggressive nature of this malignancy, clinicians should maintain a high index of suspicion when evaluating patients with unexplained neurological deficits.