Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2025; 17(6): 106848
Published online Jun 15, 2025. doi: 10.4251/wjgo.v17.i6.106848
Extensive bone metastases from an occult gastric primary: A case report
Chao-Bo Jin, Yong-Sheng Li, Juan Zhang, Jian Wu, Wei-Jing Tao
Chao-Bo Jin, Wei-Jing Tao, Department of Nuclear Medicine, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an 223300, Jiangsu Province, China
Yong-Sheng Li, Department of Rheumatism and Immunology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an 223300, Jiangsu Province, China
Juan Zhang, Department of Gastroenterology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an 223300, Jiangsu Province, China
Jian Wu, Department of Pathology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an 223300, Jiangsu Province, China
Co-first authors: Chao-Bo Jin and Yong-Sheng Li.
Co-corresponding authors: Jian Wu and Wei-Jing Tao.
Author contributions: Jin CB and Li YS collected clinical data and wrote the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Zhang J validated clinical interpretations and edited figures; Wu J was responsible for pathology validation and ethics management; Tao WJ was responsible for clinical design and manuscript finalization; Wu J and Tao WJ contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Informed consent statement: Written consent was obtained from the patient’s family to publish this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Jing Tao, MD, Professor, Department of Nuclear Medicine, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huaiyin District, Huai’an 223300, Jiangsu Province, China. weijingtao2021@vip.163.com
Received: March 13, 2025
Revised: April 9, 2025
Accepted: May 20, 2025
Published online: June 15, 2025
Processing time: 93 Days and 0.7 Hours
Core Tip

Core Tip: This case highlights an octogenarian with occult gastric cancer manifesting as extensive osteoblastic metastases initially misdiagnosed as rheumatoid arthritis. While fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) failed to detect the primary lesion, gallium-68 fibroblast-activation protein inhibitor PET/CT identified a subtle gastric antral tumor. This underscores the diagnostic utility of fibroblast activation protein inhibitor-targeted PET/CT imaging for gastrointestinal malignancies with low fluorine-18 fluorodeoxyglucose avidity and emphasizes the multidisciplinary integration of tumor markers, advanced imaging, and endoscopic surveillance in high-risk patients to detect clinically silent, aggressive cancers and mitigate diagnostic delays.