Gastric carcinoma and acute myeloid leukemia: case of double
Multiple primary cancer (MPC) is a specific malignant tumor type, manifesting as more than one primary tumor diagnosed in the same patient, either simultaneously or sequentially. Development of secondary leukemia after chemotherapy and radiotherapy is also a well-known fact. Published in the Indian Journal of Pathology and Microbiology, the authors report a rare case of untreated gastric carcinoma with the sequential development of acute myeloid leukemia (AML).

An elderly reported with complaints of a burning sensation in the upper abdomen and generalized weakness. Endoscopy showed a large ulceroproliferative growth involving the body of the stomach, with overlying slough.

Computed tomography scan revealed a malignant gastric mass with adjacent infiltration to the transverse colon near the splenic flexure, along with small anterior perigastric lymphadenopathy. On biopsy, a diagnosis of gastric Adenocarcinoma, intestinal type was confirmed,

Hematological examination revealed a total leukocyte count of 19 × 103/cumm, with 60% neutrophils, 37% lymphocytes, and 3% monocytes. The hemoglobin was 9.5 g/dL, and platelet count was normal. The patient did not undergo any kind of surgical or medical intervention.

However, the patient opted for alternative therapy with Tibetan medicine, which has a common use among the tribes of this region. Regular monthly follow-up showed decreasing hemoglobin levels up to 5.4 g/dL, whereupon he was transfused with packed red blood cells. The total leukocyte and platelet counts were normal.

In January 2017, total leukocyte count was found to be 39.3 × 103/cumm. Peripheral blood smear revealed the predominance of myeloblasts (70%). Bone marrow aspiration and biopsy examination showed hypercellularity with 90% myeloblasts. The blasts showed positive staining for Myeloperoxidase and Sudan Black stains. A final diagnosis of AML, M1 type was given.

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