Unusual bone metastasis as the initial symptom of gastric cancer--a report of four cases.

Four cases of gastric cancer presenting with bone pain due to metastasis as the initial symptom are reported. Investigations revealed solitary osteolytic metastasis in the mandible in one, and left scapula in one patient. Third patient had multiple osteosclerotic metastasis with elevation of acid phosphatase and another had multiple discrete osteolytic metastasis simulating multiple myeloma. All the primary gastric cancers were poorly differentiated adenocarcinoma and three were of Borrman type III on gross appearance. One patient had sparing of the liver inspite of extensive metastasis. Chemotherapy was in effective in two patients and the prognosis was uniformly poor.