Anabolic androgenic steroids (AAS), simply called “androgens”, represent the most widespread drugs used to enhance performance and appearance in a sporting environment. High-dosage and/or long-term AAS administration has been associated frequently with significant alterations in the cardiovascular system, some of these with severe endpoints. The induction of a prothrombotic state is probably the most life-threatening consequence, suggested by numerous case reports in AAS-abusing athletes, and by a considerable number of human and animal studies assessing the influence of exogenous androgens on hemostasis. Despite over fifty years of research, data regarding the thrombogenic potential of exogenous androgens are still scarce. The main reason is the limited possibility of conducting human prospective studies. However, human observational studies conducted in athletes or patients, in vitro human studies, and animal experiments have pointed out that androgens in supraphysiological doses induce enhanced platelet activity and thrombopoiesis, leading to increased platelet aggregation. If this tendency overlaps previously existing coagulation and/or fibrinolysis dysfunctions, it may lead to a thrombotic diathesis, which could explain the multitude of thromboembolic events reported in the AAS-abusing population. The influence of androgen excess on the platelet activity and fluid–coagulant balance remains a subject of debate, urging for supplementary studies in order to clarify the effects on hemostasis, and to provide new compelling evidence for their claimed thrombogenic potential.

Mastocytosis is a rare disease, resulting from infiltration of atypical mast cells in multiple organ and systems, pre­sen­ting with a variety of symptoms. Gastric cancer with gas­tro­in­tes­ti­nal symptomatology associated with systemic mas­to­cy­to­sis has been very rarely reported.We describe the case of a 49-year-old patient, with a long history of mas­to­cy­to­sis (cutaneous mastocytosis diagnosed from 2008, progressed to aggressive systemic mastocytosis in 2017), admitted in our clinic in 2020 with episodes of severe epi­gas­tric pain, emesis and a significant weight loss of 10 kg over the last month. The investigations revealed gastric ade­no­car­ci­no­ma. Despite the multidisciplinary approach (he­ma­to­lo­gist, oncologist, allergologist, gastroenterologist and general surgeon), the patient did not respond to on­co­lo­gi­cal chemotherapy. The peculiarity of this case lies in the as­so­cia­tion of mastocytosis with an oncological condition, where the accumulation of mast cells plays an important role in promoting angiogenesis and tumor invasion. The di­ges­tive symptoms specific to mastocytosis may have de­ter­mined a delay in the oncological diagnosis. This case em­pha­sizes the importance of multidisciplinary approach in the case of a hematological patient and of close mo­ni­to­ri­za­tion of the disease clinical course.