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An 80-year-old man had severe lumbago that was diagnosed as multiple myeloma. He was treated with melphalan, prednisone, and zoledronic acid, with a good response. However, he had severe anemia, and endoscopic examination revealed gastric cancer. He died 3 months later. Autopsy revealed verrucous gastric cancer consisting of numerous polypoid mucosal excres- cences that had metastasized to the gallbladder and urinary bladder, showing similar polypoid mucosal lesions. The cancer consisted of poorly differentiated cells (about 85%) and signet ring cells (15%) in the stomach. The cancerous tissue was not associated with a desmoplastic reaction, and the signet ring cells showed a positive reaction to cytokeratin 7 and regenerating islet-derived family member 4 antibodies. The cancer cells had a propensity to proliferate on the mucosal surface of the stomach, gallbladder, and urinary bladder.

Warty gastric cancer with polypoid metastases to the gallbladder and urinary bladder