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A 35-year-old man with a four-month history of recurrent back pain and progressive paresthesia of both legs presented with microcytic anemia and a 10-fold elevation of alkaline phosphatase (80 percent of which was derived from bone). Although an x-ray film of the thoracic and lumbar spine was normal, a magnetic resonance imaging scan of this region showed massive vertebral infiltration, with partial destruction of the deck plates and compression of the spinal canal (Panel A). One day later, the patient began to have tarry stools. At gastroscopy a signet-ring–cell carcinoma of the antrum was found. A bone marrow biopsy showed . . . [Full Text of this Article] |
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