[Diagnosis and treatment strategy of gastric cancer with ovarian metastasis].

Ovary is one of the common metastatic sites of gastric cancer. In the female patients, ovarian relapse is one of the most important causes of treatment failure for gastric cancer. The most likely mechanism of Krukenberg tumor development is via retrograde lymphatic spreading from gastric cancer. However, neither optimal treatment strategy nor standard treatment guideline for Krukenberg tumor from gastric cancer has been clearly established.The diagnostic key points consist of the previous or concomitant history of gastric cancer and the detection of ovarian solid tumors.The therapeutic regimens mainly include the metastasectomy, chemotherapy, radiotherapy and comprehensive treatment. Surgical resection of metastatic tumor combined with adjuvant chemotherapy can improve the prognosis and survival.

Krukenberg tumor after gastric bypass for morbid obesity. Bariatric surgery and gastric cancer.

Gastric bypass is one of the most frequently performed surgical procedures in bariatric surgery. A neoplasm within the gastric pouch is a somewhat infrequent complication but with important survival consequences. We present the case of a 51-year-old woman who developed an adenocarcinoma in the bypassed stomach three years after bariatric surgery; the tumour was incidentally discovered after gynaecological surgery for uterine myomas. Various diagnostic modalities for the excluded stomach were analysed.

A 36-year-old female with Krukenberg tumor from a colonic carcinoma.

Krukenberg tumor is bilateral ovarian carcinoma's metastasizing most commonly from a gastric primary followed by a colon. We report a case of 36-year-old female with bilateral ovarian mass diagnosed as Krukenberg with a work up for locating the primary site. In this case, we discuss widely the clinical aspects with histopathological features and literature review of Krukenberg tumor.

Krukenberg syndrome as a natural manifestation of tumor cell entrapment.

In summary, confusion exists among clinicians regarding the possibilities of treatment for ovarian metastases in general, and of the Krukenberg tumors in particular. The ovaries themselves are easily removable irrespective of their sizes, but disappointing long-term results of oophorectomy alone leave most surgeons with only the choice of conservative therapy unless there is a debilitating tumor mass. In most patients nothing is done until surgical palliation becomes mandatory. There is a group of patients with isolated peritoneal dissemination of gastrointestinal cancers who are eligible for new treatment strategies. This group includes patients who have small-volume peritoneal spread or who can be completely cytoreduced, and those who have no evidence of liver or extraabdominal metastases. An aggressive approach with cytoreductive surgery and intraperitoneal chemotherapy with or without additional systemic chemotherapy should be considered for the treatment of selected patients.

Primary adenocarcinoma of the appendix with bilateral Krukenberg ovarian tumors.

An unusual case of a 22-year-old white female with known chronic ulcerative colitis presented with a several-day history of lower abdominal pain and a pelvic mass. Laparotomy revealed a primary carcinoma of the appendix with Krukenberg metastasis to both ovaries. Pathologically this tumor appeared to arise from an appendix which showed no evidence of chronic ulcerative colitis and therefore could not be associated with the above-mentioned entity.

Surgical management and outcome of metachronous Krukenberg tumors from gastric cancer.

BACKGROUND AND OBJECTIVES: The question of whether resection should be performed in Krukenberg tumors from gastric cancer has yet to be adequately examined. Despite some reports on the surgical treatment of Krukenberg tumors, the outcomes after resection are not well characterized. PATIENTS AND METHODS: Using a gastric cancer database, a total of 34 patients who underwent a resection of metastatic ovarian tumors after curative surgery for gastric cancer were identified. A prospective database of these patients was reviewed for the presentation, clinical features, and outcomes after resection. RESULTS: The median age of 34 patients was 44 years (range, 24-66). The majority of patients was in the premenopausal state and had bilateral ovarian involvement. The most common presenting symptom was an abdominal mass (35.3%). Tumor size ranged from 3.5 to 20 cm with 61.8% measuring larger than 10 cm. In 17 patients who had metastatic disease confined to the pelvis, a complete gross resection (R0) was achieved. In the other 17 with the disease beyond the pelvis gross residual tumors remained after the resection (R1). The median survival of all patients was 11 months (95% confidence interval [CI] 8-14), and that of the patients rendered R0 was 18 months (95% CI, 14-22), in comparison with 9 months (95% CI, 3-15) for those with R1 resection (P = 0.0001; log-rank test). The median progression free survival was also significantly longer for the patients with R0 resection than those with R1 resection (8 months, 95% CI, 5-11 vs. 5 months, 95% CI, 4-6, P = 0.0103). Multivariate analysis identified R0 resection as the only significant factor predictive of survival. CONCLUSIONS: In the management of Krukenberg tumors after gastric cancer, a metastasectomy may significantly improve the overall and progression free survival if it could render a complete gross resection. To define the patient group that benefits most from resection, the extent of disease and resectability must be carefully evaluated before surgery.

Adenocarcinoma gástrico con metástasis ováricas (tumor de Krukenberg) en paciente de 14 años / Gastric carcinoma with ovarian metastases (Krukenberg tumour) in patient of 14 years-old

El adenocarcinoma gástrico es una neoplasia poco frecuente en pacientes menores de 15 años. Se denomina tumor de Krukenberg a la metástasis ovárica secundaria a esta neoplasia, o a otras neoplasias, que histológicamente presenten células en anillo de sello y reacción sarcomatoide del estroma. Generalmente se presenta en mujeres cuya edad promedio es de 40 años sexualmente activas; su sintomatología puede derivar de la neoplasia primaria o de la metástasis ovárica. El presente artículo expone el caso de una adolescente de 14 años, que accidentalmente autopesquisa una masa pélvica bilateral. Tras estudio imagenológico se determinó su origen anexial, se realizó una laparotomía exploradora que incluyó ooferectomía bilateral, apendicectomía y linfadenectomía. La biopsia rápida informó la presencia de células en anillo de sello en dichos tejidos. En busca de la neoplasia primaria, se realizó una endoscopia digestiva alta que evidenció un adenocarcinoma gástrico con iguales características histológicas. La biopsia definitiva confirmó el diagnóstico de tumor de Krukenberg. Se describe lo que parece el caso más precoz con primario conocido reportado y se revisa la literatura.

Tumor de Krukenberg. A propósito de un nuevo caso / Krukengerg a tumor. Report of a new case

El tumor de Krukenberg es una variedad de cáncer metastásico de estirpe epitelial que infiltra la estroma ovárica. Este término ha sido utilizado para referirse a los tumores metastásicos ováricos que contenían células típicas del aparato gastrointestinal. Su frecuencia se halla en torno al 3-8 por ciento de los tumores ováricos y la localización primaria más frecuente es la gástrica, seguida de la colónica. Su diagnóstico es controvertido y se basa en la TAC o RMN, debiéndose buscar metástasis ováricas en toda mujer intervenida de cáncer gástrico. El Doppler ultrasonográfico puede ayudar a diferenciar los tumores ováricos benignos de los malignos, siendo el mejor método para el diagnóstico inicial de estos tumores. El tratamiento debe ser quirúrgico, con la exéresis del tumor primitivo y de sus metástasis. Aportamos un nuevo caso de tumor de Krukenberg de origen gástrico, diagnosticado por tumoración pélvico-abdominal y posteriormente confirmado por la realización de TAC toracoabdominal con contraste, siendo su tratamiento quirúrgico la gastrectomía parcial y la histerectomía con doble anexectomía (AU)