Bilateral metastatic ovarian tumors (Krukenberg’s tumors) in the course of stomach cancer

Abstract 

Presented is a rare case of bilateral neoplastic metastases to the ovaries (Krukenberg’s tumors) and to the fundus of the uterus which occurred in the course of stomach cancer in a 46-year-old female who was treated surgically in the Department of Obstetrics and Gynecology of the Regional Hospital in Slupsk. The patient was admitted secondary to bilateral ovarian masses. Her past medical history included peptic ulcer disease for a few years, confirmed by gastroscopic biopsy in July of 2000. The surgery performed in our department revealed bilateral ovarian tumors, each measuring about 10 cm in diameter, which were completely removed along with the fundus of the uterus. The intraoperative histologic diagnosis was ovarian cancer. No other macroscopic neoplastic changes were found during the surgery. During surgical removal of the gastrocolic ligament a group of enlarged lymph nodes at the greater curvature of the stomach in the proximity of the spleen was incidentally noticed. The intraoperative histology of the lymph nodes described metastatic neoplasia. Another intraoperative biopsy was also performed of the stomach because of atypical clinical presentation of the ovarian cancer. The pathologic diagnosis was stomach cancer. Upon the consultation with pathologists it was concluded that the primary tumor came from the stomach while the changes in the ovaries and lymph nodes were metastatic. Thus, the surgery consisted of total hysterectomy as well as removal of the stomach along with the spleen, gastrocolic ligament and greater omentum. The distal esophagus was anastomosed with the loop of jejunum. The final result of histologic exam confirmed the location of the primary neoplastic tumor in the stomach with metastases to both ovaries, the body of uterus, and lymph nodes at the greater curvature of the stomach.