Disseminated Skeletal Secondaries as the First Presentation of a Silent Gastric Malignancy. Rare Presentation of a Gastric Cancer -Third Reported Such Case in a Female.

We report a case of gastric carcinoma which presented mainly with vague limb symptoms. 35 year old housewife had pain in her both thighs for two months duration. She was thin built and moderately nourished; had slow waddling gait; had no tenderness on the spine or lower limbs. Her lumbosacral spines X-ray had diffuse mottling of all the bones of the pelvis and spine. She had thrombocytopenia, leucocytosis, bicytopenia with polymorpho leucocytosis and atypical normoblastosis. Her MRI of all the vertebrae, sacrum, pelvis and visualized femur bilaterally suggested diffuse metastases. Ultra sonogram of abdomen and pelvis showed irregular thickening of the stomach wall, along the proximal body, fundus and cardia of the stomach. There was involvement of liver, ovaries adnexa. From the above thickened site of stomach, which was suspected to be a possible primary lesion, a biopsy was obtained, by oesophago gastro duodenoscopy. This was reported as an ulcerated gastric mucosa with underlying diffuse sheets of neoplastic cells. Some signet ring appearance consistent with a poorly differentiated diffuse type of adenocarcinoma of stomach. This case of gastric carcinoma presented with indistinct musculoskeletal symptoms to an orthopaedic surgeon. One cannot afford to miss and dismiss any vague diffuse