J Gastric Cancer.  2014 Dec;14(4):275-278. 10.5230/jgc.2014.14.4.275.

Gastric Cancer Presenting as a Krukenberg Tumor at 22 Weeks' Gestation

• Co PV
• Gupta A
• Attar BM
• Demetria M

• KMID: 2183653
• DOI: http://doi.org/10.5230/jgc.2014.14.4.275

Abstract

Gastric cancer is rare during pregnancy, and often advanced upon presentation. A Krukenberg tumor presents a diagnostic and therapeutic challenge in the pregnant patient. We present a case of a 38-year-old woman at 22 weeks' gestation who presented with worsening epigastric pain, and was found to have a left pelvic mass on ultrasound, which was confirmed by magnetic resonance imaging. She went into active labor and delivered a viable infant via vaginal delivery. An exploratory laparotomy revealed a large mass originating from her left ovary and diffuse thickening of the lesser curvature of the stomach. Frozen section investigation revealed the presence of signet cell adenocarcinoma. Subsequent upper endoscopy showed linitis plastica, while biopsy confirmed the presence of adenocarcinoma. In conclusion, the occurrence of gastric cancer in pregnancy is rare despite extremely common symptoms. The management poses a challenge because of the need for early treatment, and the continuation of the pregnancy.

Keyword

Krukenberg tumor; Stomach neoplasms; Pregnancy; Linitis plastica

MeSH Terms

Adenocarcinoma
Adult
Biopsy
Endoscopy
Female
Frozen Sections
Humans
Infant
Krukenberg Tumor*
Laparotomy
Linitis Plastica
Magnetic Resonance Imaging
Ovary
Pregnancy*
Stomach
Stomach Neoplasms*
Ultrasonography

Figure

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  Fig. 1 Ultrasound showing intrauterine pregnancy.

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  Fig. 2 Ultrasound showing left adnexal mass of heterogenous echodensity measuring around 13.4 cm in the largest diameter which was separate from the uterine mass.

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  Fig. 3 Magnetic resonance imaging showed large pelvic mass arising from the left adnexa, ascites and demonstrated edema of the mesentery and omentum.

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  Fig. 4 Ovarian tissue showing signet cell adenocarcinoma (mucicarmine stain positive, ×40).

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  Fig. 5 Esophagogastroduodenoscopy showing linitis plastica and multiple gastric erosions.

Reference

1. Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am. 2011; 40:309–334.

2. Smith LH, Dalrymple JL, Leiserowitz GS, Danielsen B, Gilbert WM. Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol. 2001; 184:1504–1512. discussion 1512-1513.

3. Kammerer WS. Nonobstetric surgery in pregnancy. Med Clin North Am. 1987; 71:551–560.

4. ASGE Standard of Practice Committee. Shergill AK, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker GA, et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012; 76:18–24.

5. Kiyokawa T, Young RH, Scully RE. Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol. 2006; 30:277–299.

6. Papantoniou N, Belitsos P, Hatzipapas I, Rodolakis A, Papaspyrou I, Antsaklis A. Excessive hirsutism in pregnancy because of Krukenberg tumor. J Matern Fetal Neonatal Med. 2012; 25:869–871.

7. Ozdegirmenci O, Kayikcioglu F, Haberal A, Ozfuttu A. Krukenberg tumor mimicking pregnancy luteoma. Gynecol Endocrinol. 2007; 23:482–485.

8. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol. 2007; 110:201–214.

9. Shimizu H, Yamasaki M, Ohama K, Nozaki T, Tanaka Y. Characteristic ultrasonographic appearance of the Krukenberg tumor. J Clin Ultrasound. 1990; 18:697–703.

10. Sarandakou A, Protonotariou E, Rizos D. Tumor markers in biological fluids associated with pregnancy. Crit Rev Clin Lab Sci. 2007; 44:151–178.

11. Sakamoto K, Kanda T, Ohashi M, Kurabayashi T, Serikawa T, Matsunaga M, et al. Management of patients with pregnancy-associated gastric cancer in Japan: a mini-review. Int J Clin Oncol. 2009; 14:392–396.

12. Ueo H, Matsuoka H, Tamura S, Sato K, Tsunematsu Y, Kato T. Prognosis in gastric cancer associated with pregnancy. World J Surg. 1991; 15:293–297. discussion 298.