It is important to distinguish between primary ovarian cancer and metastatic tumors in the ovary because their management is different, in terms of treatment and follow-up.
We report the perioperative management of a year-old female patient with bilateral Krukenberg tumors. Este important să se facă distincţia între cancerul ovarian primar şi tumorile metastatice ale ovarului, deoarece managementul lor este diferit în ceea ce priveşte tratamentul şi urmărirea.
Raportăm managementul perioperator al unei paciente de 40 de ani, cu tumori bilaterale Krukenberg. Cuvinte cheie tumora Krukenberg cancer gastric imunohistochimie Introduction Ovarian tumors comprise a heterogeneous group of lesions, displaying distinct tumor pathology and gastric cancer with peritoneal carcinomatosis potential and being subclassified into several categories based on two criteria: the degree of epithelial proliferation and invasion and the histotype of the epithelium composing the tumors 1.
In particular, Krukenberg tumors are represented by metastases of mucin-secreting signet ring cell cancer, arising primarily from gastric cancer with peritoneal carcinomatosis gastric carcinoma, to ovarian tissues 2.
The clinical presentation of Krukenberg tumors includes abdominal or pelvic pain, bloating, ascites, unexplained lethargy, irregular period and pain during sexual intercourse. Krukenberg tumors can occasionally provoke a reaction of the ovarian stroma which leads to hormone production, that results in vaginal bleeding, a change in menstrual habits, hirsutism, or occasionally virilization as a main symptom 5,6.
Regarding the paraclinical diagnostic, most imaging features are non-specific, consisting of predominantly solid components or a mixture of cystic and solid areas; typically, those tumors are described sonographically as bilateral ovarian masses, with an irregular hyperechoic solid pattern, with clear well defined margins and moth-eaten cyst formation 7.
Deep invasion, lymph node involvement, and peritoneal metastasis are more frequent in gastric SRCC compared with other subtypes of gastric cancer, so the prognosis of Krukenberg tumor is reticent 9. Case report We report the case of a year-old female patient, without a significant pathological personal history, who has been admitted two months ago in the Department of Gynecology of a regional hospital, accusing pelvic pain and dysfunctional menstrual cycles. She was diagnosed with bilateral ovarian cysts for which reevaluation was recommended.
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About 3 weeks ago, the patient was referred to the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest for an interdisciplinary consultation. The transvaginal ultrasound showed two non-homogeneous tumors, predominantly with a tissue aspect, alternating with hypo-echogenic areas and zones of intratumoral necrosis, without capsular breakage; uterus of normal size and echogenity, evidence of fluid within the pouch of Douglas 10 mm.
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CA tumor markers were recommended. The local clinical examination gastric cancer with peritoneal carcinomatosis normal non-specific vaginosis for which the patient received antibiotic and antiinflammatory treatment for 7 days.
When reevaluating, the patient showed discrete relief of symptoms, with persistence of pelvic pain, and accusing meteorism.
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Но никто из хранителей зоопарка не пережил бомбардировку, о нем вообще сохранилось очень мало материала, и мы едва ли сумеем подтвердить мою - А что такое гипотеза.
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Ричард и Наи взяли Тамми, Тимми, Бенджи и младших в коридор, безуспешно пытаясь утихомирить их, и повели от большого зала к вертикальному коридору с острыми выступами, опускавшемуся глубже в логово октопауков.
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The patient was admitted in the hospital for reevaluation and for establishing the therapeutic conduct. We performed a new transvaginal ultrasound which indicated the same aspects, except for increased peritoneal fluid 30 mm in the recto-uterine pounch - Figure 1 and Figure 2.
Figure 1. Tumoral transformation of the right ovary; non-homogenous structure, predominantly tisular Figure 2.
Figure 3. CT of thorax - note the lack of pulmonary metastases Figure 4.
CT of pelvis - note the presence of bilateral ovarian tumors with predominant tisular and The general condition of the patient deteriorated, with the occurrence of vomiting and pain in the right hypochondria and the epigastrium. General detoxifiere usoara si rapida consultation was requested to exclude a sub-occlusive syndrome, followed by upper endoscopy which showed a normal aspect, with the exception of enlarged gastric cancer with peritoneal carcinomatosis in the vertical portion of the stomach, but which distended fully under insufflation.
Material and methods: A retrospective study was carried out on series of patients admitted in the period June - March The duration of hospitalization was between 1 and 61 days, with an average of The data from observation files, the operating protocols, pathology reports and follow-up files were collected and analyzed.
The hematology consult confirmed the diagnosis of coagulopathy of possibly paraneoplastic etiology. We decided to improve the coagulopathy by the administration of fresh frozen plasma. Under general anesthesia, an exploratory laparotomy was performed see Figure 5.
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We detected peritoneal gastric cancer with peritoneal carcinomatosis with infra-centimetric disseminations on the epiploon and mesentery. We also observed free peritoneal fluid in a small amount and multiple liver metastases with various sizes cm.
Figure 5. Intraoperative images. A - The macroscopic aspect of the two ovaries that were enlarged, but without capsular breakage; B - The macroscopic aspect of the liver - note the presence of multiple metastases; C - The macroscopic aspect of the intestinal loops and mesentery - note peritoneal carcinomatosis; D - Sectioned left ovary - note the presence of large tumors that distorted the normal anatomy We decided and practiced tumor cytoreduction through detoxifiere 1 saptamana hysterectomy with bilateral oophorectomy, with the piece being sent to histopathological examination histopathological extemporaneous examination showed undifferentiated ovarian carcinoma with Mullerian cells ; tactical omentectomy and biopsy of all secondary lesions were also performed.
The postoperative evolution was favorable with the improvement of genital symptomatology; the patient was discharged after 5 days and she was guided to the Oncology Department gastric cancer with peritoneal carcinomatosis follow the specialized treatment after receiving the final histopathological result.
Managementul perioperator al unui pacient cu tumoră Krukenberg - studiu de caz
After 4 days she returned to the Emergency Room for epigastric gastric cancer with peritoneal carcinomatosis, vomiting, intense meteorism and absent intestinal transit. An abdominal radiography was performed which showed hydroaeric levels. The patient was admitted in the Department of General Surgery with the diagnosis of occlusive syndrome.
A surgical reintervention in a multidisciplinary team was performed.