Localized Linitis Plastica With Gastric Amyloidosis Followed by Multiple Myeloma

What happened, in summary

A woman in her 50s developed fatigue, a 5 kg weight loss over 2 months, epigastric pain, nausea, and intermittent bilious vomiting. CT showed diffuse thickening of the stomach wall but no distant or peritoneal spread. Biopsies suggested a diffuse gastric carcinoma together with amyloid deposits. Staging laparoscopy and peritoneal washings did not show extension beyond the stomach, supporting localized linitis plastica.

She received neoadjuvant cisplatin and 5-fluorouracil, followed by total gastrectomy with esophagojejunostomy. Surgical pathology confirmed multifocal high-grade neoplasia and adenocarcinoma extending through the stomach muscle into subserosal fat. Extensive amyloid deposits were present throughout the stomach and in 7 of 20 lymph nodes, but the lymph nodes contained no cancer. Surgical margins were clear. Bone marrow and blood testing at that time did not show multiple myeloma.

She remained in clinical remission for 3 years. When severe anemia, fatigue, and palpitations later developed, CT showed no recurrent gastric disease. Bone marrow biopsy instead found 20% monoclonal plasma-cell infiltration, establishing a separate diagnosis of symptomatic multiple myeloma. She received 9 cycles of bortezomib with dexamethasone and later lenalidomide, with a bone marrow transplant planned but not yet performed. These therapies treated the myeloma rather than the gastric cancer. Her case required long-term coordination across oncology, hematology, gastroenterology, cardiology, radiology, and pathology because localized gastric amyloidosis later became systemic and accompanied the new blood cancer.