A 71-year-old man was admitted to the Internal Medicine Department for the study of constitutional syndrome.
During the previous 6 months she had experienced progressive deterioration manifested by asthenia, anorexia, weight loss of about 20 kg and inability to walk.
His personal history included smoking and heavy drinking up to 23 years before and having type 2 diabetes mellitus and prostatism of approximately 5 years of evolution.
Physical examination revealed a patient with chronic brachychic disease, pale skin and mucous membranes and generalized decrease in strength in all four limbs.
No lymphadenopathies.
Growing in the left lung base
Pain at percussion of the spine, more intense at the cervical and dorsal levels.
Abdomen blando and depresible, painful to affectation in right hypochondrium and periumbilical area, where it is observed at inspection and normal appearance of a nodule with hard consistency, cm.
No visceromegaly.
Rectal examination showed a slightly enlarged prostate without irregularities, the rest of the physical examination being normal.
The laboratory tests showed ALT: 47 U/l; GGT: 259 U/l; alkaline phosphatase: 277 U/l; Urates 2.29 mg/dl and thrombocytosis.
VSG 41 mm at 1 hour.
Rest of the general protocol that includes TSH within normal limits.
Ferritine: 515 ng/ml; absence of M in the alpha-fetoprotein proteinogram; PSA: 1 1 11.5 ng/ml (normal values); Anvalue 5 normal U/ml up to 379.9 ng/ml).
24-hour uricosuria was not performed.
FNAB of the periumbilical nodule demonstrated the presence of malignant cells suggestive of adenocarcinoma and after that we proceeded to search for the primary tumor with: chest X-ray showing an alveolar infiltrate in the left lower lobe, abdominal disfiable ultrasound.
Bone scintigraphy showed multiple hypercapsule accumulations in axial and peripheral skeleton.
Toco-abdominal computed tomography revealed a 1.4 x 1.6 cm nodule in the right upper lobe, which contacts the posterior visceral lobe, which appeared thickened and with lytic lesions in the costal arch.
Lytic metastases at the level of the dorsal spine and sternum.
Minimum bilateral pleural effusion.
Multiple focal hepatic lesions in segment III with vascular pattern compatible with hemangiomas.
A 1.1 cm lesion in segment IV probably metastatic.
A 1.4 cm nodule in the left adrenal gland suggestive of adenoma.
Hypodense tail lesion of the pancreas of 1.7 x 1 cm possibly related to primary tumor.
Tumor implants in soft tissues, one of them at the periumbilical level, compatible with a nodule of the sister Joseph, and another with right iliac muscle, with metastatic bone in the lumbar pelvis.
After performing the above-mentioned imaging techniques, which do not define a clear origin of the carcinomatosis, the patient died two weeks after hospital admission.
