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Case Report
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| Diffuse gastric cancer with Krukenberg tumor: A case report | ||||||
| Manraj Khosla1, Ali Imran2, Panagiotis Fidias3 | ||||||
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1MD, Department of Internal Medicine, St Joseph's Hospital & Medical Center, Creighton University Medical School, Phoenix, AZ, USA.
2MD, Ross University School of Medicine, Tempe, AZ, USA. 3MD, Department of Oncology, Massachusetts Gender Hospital, Harvard, Boston, MA, USA. | ||||||
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| How to cite this article |
| Khosla M, Imran A, Fidias P. Diffuse gastric cancer with Krukenberg tumor: A case report. Int J Case Rep Images 2016;7(11):733–737. |
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Abstract
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Diffuse gastric carcinoma (DGC) is histologically characterized by increased intracellular mucin production, leading to a "signet ring cell differentiation" in tumor cells. Signet-ring tumor cells are often rapidly progressive in nature, with tumor cells diffusely infiltrating the stomach, leading to desmoplasia and thickening of the gastric wall (linitis plastica). Like intestinal gastric carcinoma (IGC), DGC can be associated with H. pylori infections, among other environmental factors such as smoking, alcohol, and socioeconomic status. DGC, however, is characterized by a higher mortality and poorer prognosis than IGC due to its rapid progression, higher metastatic potential, and delayed diagnosis. Common presentation in those with DGC include weight loss, generalized abdominal pain, nausea and vomiting. In our specific case, the rare presentation of DGC with metastasis to the peritoneum, small intestine, colon, left ovary and fallopian tube can be appreciated. A 54-year-old female presented with consistent, generalized abdominal pain, leading to an exploratory laparotomy for suspected adhesions. Examination revealed numerous tumors throughout the abdomen and pelvis, with omental and mesenteric implants. Multiple biopsies of the ovaries, mesenteric implants, and omental implants revealed well-defined glands lined by moderately atypical nuclei and focal luminal necrosis. Diagnosis of DGC with metastatic spread and Krukenberg tumors (KT) was made and treatment was initiated with palliative chemotherapy. DGC with KT is remarkably rare, as only 1% of metastatic ovarian tumors result from gastric primaries. The grim prognosis is due to rapid disease progression, advanced stage at presentation, and late diagnosis. As such, effective treatment for this subset of patients cannot be initiated.
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Keywords:
Diffuse gastric carcinoma, Krukenberg tumors, Signet ring cells
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Author Contributions
Manraj Khosla – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Ali Imran – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Panagiotis Fidias – Analysis and interpretation of data, Drafting the article, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Manraj Khosla et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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