Very late recurrence of gastric cancer with bone marrow involvement and microangiopathic hemolytic anemia as a stem cell disease: a lesson for future

Gastric adenocarcinoma, is a known aggressive malignancy with local behavior showing systemic relapse in the abdomen and other organs , with bone marrow metastasis being present in only 1 to 11% of cases. The average time of relapse is 3.5 years. Here, we describe, an interesting case with thrombotic microangiopathic hemolytic anemia, which is a known gastric cancer complication.4 The mechanisms of this anemia are tumor related effect on endothelial cells.In this case repot, a very late relapse, is discussed to observe this cancer as a systemic disease even in the early stage of presentation, like breast cancer, and also consider this disease as a new model for the presentation of stem cell theory of cancer progression