What happened, in summary

A 50-year-old man was hospitalized after developing weakness on his left side. For several weeks he had also experienced widespread bone and joint pain, loss of appetite, and a 10 kg weight loss. Examination found enlarged left supraclavicular lymph nodes and multiple hard subcutaneous nodules. Blood tests showed severe abnormalities in clotting, consistent with disseminated intravascular coagulation, as well as markedly elevated AFP, CEA and CA 19-9 tumor markers.

Imaging showed a highly disseminated cancer, with metastases involving the liver, lymph nodes, bone, muscle and subcutaneous tissue. He also had venous and arterial thromboses, splenic and renal infarcts, and multiple ischemic brain lesions. A biopsy of a subcutaneous nodule showed a high-grade gastric carcinoma with mixed pleomorphic and signet-ring cells. Tumor cells were focally positive for AFP, supporting the diagnosis of AFP-producing gastric carcinoma.

The disease was already Stage IV at presentation and was accompanied by a severe cancer-associated clotting disorder. Before systemic treatment could begin, he developed a seizure and confusion. Brain imaging then showed a massive intraventricular hemorrhage. His condition deteriorated rapidly, and he died shortly afterward. The case illustrates the unusually aggressive course that AFP-producing gastric cancer can sometimes take when it presents with widespread metastases and major coagulation complications.