Tumores anexiales incidentales en cirugía abdominal / Incidental adnexal tumors in abdominal surgery

La posibilidad de encontrar una neoplasia benigna o maligna del ovario, de forma inesperada durante una intervención quirúrgica abdominal, es una realidad para todos los especialistas en cirugía. Si bien en muchos casos se tratará de una lesión benigna, el riesgo de cáncer no debe subestimarse, ya que, por ejemplo, la ruptura intraoperatoria de una lesión quística maligna puede reestadificar a una paciente con cáncer de ovario del estadio IA al IC, con todas las consecuencias que esto implica, como la necesidad de requerir quimioterapia adyuvante y tener un peor pronóstico. Por otro lado, en mujeres premenopáusicas debe discutirse con la familia o la paciente (idealmente) el riesgo e implicaciones de la ooforectomía uni o bilateral, incluso si esto amerita dejar el quirófano para obtener el consentimiento, o posponer el procedimiento definitivo para un segundo tiempo. La consulta intraoperatoria a un ginecólogo, siempre que sea posible, se debe llevar a cabo con el fin de respaldar la conducta adoptada. Conocer el manejo adecuado de las masas anexiales encontradas de forma incidental durante una cirugía abdominal, es una prioridad para todos los cirujanos generales.

The possibility of finding a benign or malignant neoplasm of the ovary unexpectedly during abdominal surgery is a reality for all specialists in surgery. Although in many cases it will be a benign lesion, the risk of cancer should not be underestimated, since, for example, the intraoperative rupture of a malignant cystic lesion may well re-stage a patient with ovarian cancer from stage IA to IC, with the consequences that this implies, such as the need for adjuvant chemotherapy and a worse prognosis. On the other hand, in premenopausal women, the risk and implications of unilateral or bilateral oophorectomy should be discussed with the family or the patient (ideally), even if this implies leaving the operating room to obtain consent, or postponing the definitive procedure for a second time. Intraoperative consultation with a gynecologist, whenever possible, should be carried out in order to support the adopted behavior. Knowing the proper management of adnexal masses found incidentally during abdominal surgery is a priority for all general surgeons.

Ovarian metastasis from colorectal adenocarcinoma / Metástase ovariana de adenocarcinoma colorretal

Introduction: Ovarian metastases of gastrointestinal origin, also called Krukenberg tumors, have a guarded prognosis. Physicians need to look for alternatives in diagnosis and treatment for this clinical condition in order to improve the outcome of the patients. Objectives: To report the experience of the authors in the treatment of these patients, and to perform a review of the literature on the epidemiology, clinical presentation, diagnosis, treatment, and prognosis for ovarian metastases from colorectal cancer. Methods: We collected clinical information regarding the patients treated for ovarian metastasis from colorectal adenocarcinoma at our coloproctology service, and performed a search on the PubMed database using the terms colorectal cancer, ovarian metastasis, Krukenberg tumor and surgery. Conclusion: Large abdominal tumors are the most frequent presentation of ovarian metastasis from colorectal cancer. The diagnosis is based on a histopathological analysis, levels of carcinoembryonic antigen (CEA) and cancer antigen 125 (CA-125), and immunohistochemical studies for the cytokeratin 20 (CK20), caudal-type homeobox 2 (CDX2) and vilina markers. Citoreductive surgical procedures are the most promising approach to treatment, with the highest impact on overall survival. The prognosis is negatively influenced by the extent of the metastasis, by citoreductive surgical procedures with persistence of macro- or microscopic foci of the disease, and by low scores on the general well-being index of the patient. (AU)

Introdução: As metástases ovarianas de tumores gastrointestinais, também chamadas de tumores de Krukenberg, são neoplasias de prognóstico reservado. Exigem conhecimento de alternativas diagnósticas e terapêuticas para garantir melhora da sobrevida das pacientes. Objetivos: Relatar a experiência dos autores no tratamento dessas pacientes, e fazer uma revisão da literatura sobre a epidemiologia, apresentação clínica, diagnóstico, tratamento e prognóstico das metástases ovarianas do câncer colorretal. Métodos: Foi realizada uma coleta de informações clínicas de pacientes tratados por metástases ovarianas de adenocarcinoma colorretal em nosso serviço de coloproctologia, em conjunto com uma pesquisa na base de dados PubMed com os termos colorectal cancer, ovarian metastasis, Krukenberg tumor, e surgery. Conclusão: Volumosas massas abdominais constituem a principal apresentação clínica da doença. As alternativas diagnósticas incluem a avaliação histopatológica, a identificação dos níveis de antígeno cárcino-embriônico (ACE) e de antígeno de câncer 125 (CA-125), e exame imunoistoquímico de espécimes cirúrgicos para os marcadores citoqueratina 20 (CK20), homeobox 2 do tipo caudal (CDX2), e vilina. O tratamento citorredutor completo demonstrou o maior impacto na sobrevida dos pacientes. O prognóstico é influenciado negativamente pela extensão da doença metastática, por cirurgia citorredutiva com persistência focos microscópicos ou macroscópicos da doença, e baixo escore de índice de bem-estar geral do paciente. (AU)

A challenge for colorectal surgeons: pathogenesis, progression and management of the secondary tumors of the ovary / 中华胃肠外科杂志

A common clinical problem encountered by colorectal surgeons is the secondary tumors of the ovary (STO), particularly in young female patients. Most STO are from the digestive tract, and the known possible metastatic mechanisms include lymphatic, hematogenous, and intraperitoneal spreading. The molecular and histopathological characteristics of STO from different sites are diverse. It is particularly important to correctly identify the origin and feature of STO, which should be clarified by combining medical history, histopathology, immunohistochemistry, molecular biology, imaging and other means. The prognosis of patients with STO is poor in general. Comprehensive therapies based on surgical resection can benefit some patients. There is no specific treatment for STO at present, but not giving up easily on these patients is the right choice that every surgeon should understand.

Terapia de conversión en cáncer gástrico estadio IV: a propósito de un caso / Case Report of Conversion Therapy in Stage IV Gastric Cancer

Resumen Se reporta el caso de una paciente de 47 años, con diagnóstico inicial de un tumor de Krukenberg por una lesión anexial de 10 cm de diámetro y una lesión corporal gástrica de 3 cm. La biopsia mostró un adenocarcinoma pobremente diferenciado con células en anillo de sello. Una laparoscopia inicial mostró un índice de carcinomatosis peritoneal (ICP) de 24, por lo cual se le indica a la paciente quimioterapia con intención paliativa (cisplatino y capecitabina). Con mejoría clínica importante, respuesta adecuada y favorable a la quimioterapia, la paciente se remitió a una salpingo-ooforectomía bilateral. Continúa con quimioterapia evidenciándose mejoría de las imágenes tomográficas y una excelente respuesta clínica. Por este motivo, se decide en conjunto con la familia llevarla a cirugía. Se le practica una gastrectomía total con linfadenectomía D2 con intención curativa. La paciente recibe quimioterapia con capecitabina y cisplatino por 3 meses más, hasta cuando se evidencia compromiso ganglionar paraaórtico, por lo que es necesario reiniciar la quimioterapia con un nuevo esquema, entonces se le formula irinotecán. La paciente completa 22 meses desde el diagnóstico inicial, la condición clínica es muy buena y está asintomática.

Abstract We report the case of a 47-year-old patient initially diagnosed with a Krukenberg tumor, an adnexal lesion 10 cm in diameter and a 3 cm lesion in the gastric corpus. A biopsy showed a poorly differentiated adenocarcinoma with signet ring cells. Initial laparoscopy showed an index of peritoneal carcinomatosis of 24 which indicated chemotherapy with palliative intent (cisplatin and capecitabine). The patient improved significantly and underwent a total hysterectomy with salpingo-oophorectomy. Chemotherapy continued with excellent clinical response as evidenced in CT scans. Together with the patient's family, it was decided that she should undergo surgery. A total gastrectomy with D2 lymphadenectomy with curative intent was performed. The patient continued to receive capecitabine and cisplatin for three more months until para-aortic lymph node involvement was demonstrated and it became necessary to restart chemotherapy with a new scheme using iriniotecan. The patient has completed 22 months after the initial diagnosis in very good and clinical condition without symptoms.

Tumor de Krukenberg del ovario asociado a teratoma maduro / Krukenberg tumor of the ovary associated with mature teratoma

Se reporta un caso excepcional de tumor de Krukenberg ovárico bilateral asociado a teratoma maduro encontrado en una mujer de 54 años. La ecografía mostró al lado derecho tumor ovárico sólido de 55 mm y al lado izquierdo tumor quístico de 125 mm. Se realizó histerectomía total, salpingooforectomía bilateral, resección del epiplón mayor y muestras peritoneales. Al tercer día postcirugía, la paciente presentó signos de tromboembolismo pulmonar masivo y aunque recibió terapia anticoagulante falleció al quinto día postoperatorio. El estudio histológico mostró infiltración masiva de carcinoma de células en anillo positivas para citoqueratina en ambos ovarios. El ovario derecho mostró la forma sólida clásica del tumor de Krukenberg mientras que el ovario izquierdo correspondió a un quiste dermoide con infiltración tumoral de carcinoma de células en anillo en la pared.

An exceptional case of bilateral Krukenberg tumor of the ovary associated with mature teratoma presented in a 54 years old patient is reported. The ultrasound showed a 55 mm solid right ovarian tumor and a 125 mm left cystic ovarian tumor. Hysterectomy and bilateral salpingoophorectomy was performed including omental resection and peritoneal biopsies. Massive pulmonary embolism was detected in the third day after the surgery. Even anticoagulant therapy was established the patient died in the fifth postoperative day. The histological study revealed massive infiltration of signet ring cell carcinoma with positive expression for cytokeratin in both ovaries. The right ovary showed the classical solid form of the tumor. The left ovary was a dermoid cyst with signet ring cell carcinoma infiltrating the cystic wall.

Krukenberg tumors of gastric origin versus colorectal origin

OBJECTIVE: The aim of this study is to compare the each clinical manifestation related with its mean survival time of Krukenberg tumors (KTs) of gastric origin versus with that of colorectal origin. METHODS: A total of 156 consecutive patients diagnosed with KTs of the ovary who underwent surgical treatment at a single institution between 2001 and 2010 were retrospectively evaluated. Each clinical manifestation related with its mean survival time compared two different groups. Survival analyses and comparisons were performed using the Kaplan-Meier method. RESULTS: Among the 156 patients with KT, 111 patients with KTs of gastric origin and 45 patients with KTs of colorectal origin were identified. For all patients with KTs, median survival time was 22.7 months. Each mean survival time among all patients with KTs of gastric origin and colorectal origin was 19.2 months and 27.3 months. The results showed that mean survival time of postmenopausal patients was 19.0 months compared with 32.5 months for premenopausal patients (P=0.015). Among all patients, mean survival time of those with metachronous cancer was longer than those with synchronous cancer (P=0.001). In all cases, especially when only one ovary was invaded, the mean survival time was relatively higher (P=0.001). CONCLUSION: Patients with KTs of colorectal origin had a better prognosis than those of gastric origin. In all cases of KT, the mean survival time was significantly longer in postmenoposal patients, metachronous disease and unilateral ovarian involvement. Notably, synchronous, ascites positive, and ovary only metastasis showed more longer mean survival time in the KTs of colorectal origin than KTs of gastric origin.

Comparison of Surgery Plus Chemotherapy and Palliative Chemotherapy Alone for Advanced Gastric Cancer with Krukenberg Tumor / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted to validate the survival benefit of metastasectomy plus chemotherapy over chemotherapy alone for treatment of Krukenberg tumors from gastric cancer and to identify prognostic factors for survival. MATERIALS AND METHODS: Clinical data from 216 patients with Krukenberg tumors from gastric cancer were collected. Patients were divided into two arms according to treatment modality: arm A, metastasectomy plus chemotherapy and arm B, chemotherapy alone. RESULTS: Overall survival (OS) was significantly increased in arm A relative to arm B for patients initially diagnosed with stage IV gastric cancer (18.0 months vs. 8.0 months; p < 0.001) and those with recurrent Krukenberg tumors (19.0 months vs. 9.0 months; p=0.002), respectively. Metastasectomy (hazard ratio [HR], 0.458; 95% confidence interval [CI], 0.287 to 0.732; p=0.001), signet-ring cell pathology (HR, 1.583; 95% CI, 1.057 to 2.371; p=0.026), and peritoneal carcinomatosis (HR, 3.081; 95% CI, 1.610 to 5.895; p=0.001) were significant prognostic factors for survival. CONCLUSION: Metastasectomy plus chemotherapy offers superior OS when compared to palliative chemotherapy alone in gastric cancer with Krukenberg tumor. Prolonged survival applies to all patients, regardless of gastric cancer stage. Metastasectomy, signet-ring cell pathology, and peritoneal carcinomatosis were prognostic factors for survival. Future prospective randomized trials are needed to confirm the optimal treatment strategy for Krukenberg tumors from gastric cancer.

Diagnostic value of combined detection of HNF-1β and Napsin A in the diagnosis of ovarian clear cell carcinoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the diagnostic value of HNF-1β and Napsin A for ovarian clear cell carcinomas, serous carcinomas, endometrioid adenocarcinomas and metastatic Krukenberg tumors.</p><p><b>METHODS</b>Immunohistochemical EnVision method was used to detect the expression of HNF-1β and Napsin A in 38 cases of ovarian clear cell carcinoma, 30 cases of high-grade serous carcinoma, 22 cases of endometrioid adenocarcinoma and 16 cases of metastatic Krukenberg tumor. Expression of HNF-1β and Napsin A were compared, and sensitivity and specificity of clear cell carcinoma of the ovary were analysed.</p><p><b>RESULTS</b>The positive rate of HNF-1β in the ovarian clear cell carcinoma was 100%(38/38), higher than those in high-grade serous carcinoma and endometrioid adenocarcinoma (P<0.05), although significant difference was not observed from that of metastatic Krukenberg tumor (P>0.05). Napsin A expressed in 97.4% (37/38) of ovarian clear cell carcinoma, 6.7% (2/30) of high-grade serous carcinoma, 22.7% (5/22) of endometrioid adenocarcinoma. Napsin A expression in clear cell carcinoma was higher than those in high-grade serous carcinoma and endometrioid adenocarcinoma (P<0.01), and no expression of Napsin A was seen in metastatic Krukenberg tumor (P>0.05). The sensitivity and specificity of HNF-1β in the diagnosis of ovarian clear cell carcinoma were 100% and 52.9%, those of Napsin A were 97.4% and 91.2%, those of both HNF-1β and Napsin A were 97.4% and 91.2%, respectively. The sensitivity and specificity of HNF-1β or Napsin A in the diagnosis of ovarian clear cell carcinoma were 100% and 52.9%, respectively.</p><p><b>CONCLUSIONS</b>HNF-1β is a more sensitive marker for the diagnosis of ovarian clear cell carcinoma, whereas Napsin A is a more specific marker. The combined detection of HNF-1β and Napsin A may be helpful for the diagnosis of clear cell carcinoma of the ovary.</p>

Tumor de Krukenberg / Krukenberg tumor

Introducción: el Krukenberg es un tumor metastático y representa del 1 por ciento al 2 por ciento de los tumores de ovario. El estómago es en el 70 por ciento de los casos la localización primaria más frecuente, seguidos por colon, apéndice y mama. El pronóstico es desfavorable y la evolución es rápida. Objetivo: describir un caso clínico de una paciente con tumor de Krukenberg. Presentación del caso: mujer de 53 años que consulta por sangramiento posmenopáusico a tipo manchas y dolor bajo vientre. Antecedentes personales de carcinoma gástrico, litiasis vesicular, nódulo de mama e hipertensión arterial. Se realizó estudio sonográfico ginecológico con marcadores para tumor de ovario positivos. Marcadores tumorales negativos. Resultados: hallazgo transoperatorio: se observó útero miomatoso y ambos ovarios multiloculados, superficie de revestimiento lisa de contenido mucinoso, con áreas sólidas de coloración heterogénea y consistencia renitente. Se realizó histerectomía con doble anexectomía. Conclusiones: el Krukenberg, tumor metastásico de ovario, es una entidad rara con mal pronóstico luego de su diagnóstico. Aún así la resección de dicha lesión metastásica es la primera recomendación la cual parece mejorar la sobrevida, seguida de terapia sistémica paliativa.

Introduction: Krukenberg tumor is metastatic and it accounts for 1 percent to 2 percent of ovarian tumors. Stomach is the most common primary location in 70 percent of cases, followed by colon, appendix, and breast. The prognosis is poor and its evolution is rapid. Objective: to describe a case of a patient with Krukenberg tumor.Case presentation: a 53 year old woman was consulted due to menopausal bleeding in stains and lower abdomen pain. She had personal history of gastric carcinoma, gallstones, breast nodule and hypertension. Gynecologic sonographic study was performed with positive tumor markers for ovarian cancer and negative tumor markers.Results: intraoperative finding: fibroid uterus and both ovaries were loculate, smooth surface coating of mucinous content with solid areas of color and adverse heterogeneous consistency was observed. Hysterectomy with oophorectomy was performed.Conclusions: Krukenberg, metastatic ovarian tumor is a rare entity with poor prognosis after diagnosis. Still, resection of the metastatic lesion is the first recommendation which appears to improve survival, followed by palliative systemic therapy.

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

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.

Fibroma ovárico con células estromales en anillo de sello: un tumor extremadamente infrecuente: diagnóstico diferencial del tumor de Krukenberg / Ovarian fibroma with stromal signet-ring cells: differential diagnosis of Krukenberg tumor

La presencia de "células en anillo de sello" en el tejido ovárico es el marcador histológico clásico del tumor de Krukenberg. Un adenocarcinoma metastásico altamente agresivo y de baja sobrevida. En cambio, los fibromas ováricos son tumores del estroma generalmente benignos. Presentamos un caso muy infrecuente de fibroma celular con presencia de células en anillo de sello y revisamos los criterios para el diagnóstico diferencial con el tumor de Krukenberg.

The presence of signet-ring cells in ovarian tissue is classically described as histological marker of Krukenberg tumor. It is highly aggressive metastatic adenocarcinoma with low survival. In contrast, ovarian fibroid is a stromal tumor usually benign. We present a very rare case of cellular fibroma with presence of signet-ring cells and we review the criteria for differential diagnosis of Krukenberg tumor.

Friedrich Krukenberg, el del tumor de Krukenberg: a propósito de una serie de casos / Friedrich Krukenberg of Krukenberg's Tumor: Report of a series of cases

El tumor de Krukenberg (descrito por un médico alemán que tenía el mismo nombre) es un tumor de ovario que representa la metástasis de una tumoración primaria usualmente ubicada en el estómago. En este trabajo se realiza una breve reseña histórica y se presentan cinco casos manejados en nuestro servicio, con el fin de mostrar la complejidad de su diagnóstico, el abordaje terapéutico y el pésimo pronóstico que esta enfermedad tiene.

Krukenberg's tumor is an ovarian tumor first described by the German physician Friedrich Krukenberg. It is a metastasis of a primary tumor which is usually located in the stomach. This article presents a brief overview of the history of these tumors and a series of 5 cases which were handled in our service. The aim of this article is to demonstrate the complexity of this diagnosis, the therapeutic approach, and the pessimistic prognosis that this condition has.

Adenocarcinoma mucoproductor de colon con infiltración de estómago y metástasis ováricas (tumor de Krukenberg) / Colon mucoproducing adenocarcinoma with stomach infiltration and ovarian metastases (Krukenberg's tumor)

Se presenta una paciente femenina de 29 años, operada de urgencia por presentar un gran tumor que incluía cuerpo gástrico y colon trasverso, con una perforación gástrica. Se realizó una gastrectomía subtotal con colectomía trasversa en bloque que incluyó el epiplón mayor. El diagnóstico histológico fue adenocarcinoma túbulo papilar mucoproductor de origen colónico, que infiltra hasta la serosa y pared gástrica. Se realizó tratamiento adyuvante con poliquimioterapia. Diez meses después presenta un tumor en hipogastrio, que al tacto vaginal, correspondía a los órganos genitales, sospecha clínica que confirman el ultrasonido abdominal y la tomografía axial computarizada. El hallazgo transoperatorio fueron tumores voluminosos de ambos ovarios, y otro tumor que afectaba la unión rectosigmoide. Se realizó una histerectomía radical con ooforectomía bilateral y sigmoidectomía, se reseca la porción proximal del recto, y se cierra tipo Hartman. El diagnóstico histológico final fue metástasis en serosa uterina e intestinal, y en ambos ovarios de adenocarcinoma mucoproductor, túbulo papilar de intestino previamente diagnosticado (tumor de Krukenberg). Se complementó el tratamiento con poliquimioterapia adyuvante(AU)

This is the case of a woman aged 29 operated on of emergency due to a tumor involving gastric body and transverse colon with gastric perforation. A subtotal gastrectomy with block transverse colectomy including the greater omentum was carried out. The histological diagnosis was a mucoproducing papillary tubular adenocarcinoma of colonic origin infiltrating to serosa and gastric wall. An adjuvant treatment was applied with poly-chemotherapy. Ten months later appears a hypogastric tumor which at vaginal manual examination corresponding to genital organs, clinical suspicion confirmed by abdominal ultrasound and computerized axial tomography. The transoperative findings were bulky tumors of both ovaries and another tumor involving the rectosigmoid joint. A radical hysterectomy with bilateral oophorectomy and sigmoidectomy was carried out with resection of proximal rectal portion with type Hartman closure. The final histological diagnosis was a metastasis in uterine and intestinal serosa and in both ovaries a mucoproducing adenocarcinoma, previous papillary tubule was also diagnosed (Krukenberg's tumor). Treatment was applied using adjuvant poly-chemotherapy(AU)

Tumor de Krukenberg / Krunkenberg's tumor

El tumor de Krukenberg supone el 30-40 por ciento de los cánceres metastásicos al ovario y el 1-2 por ciento de todos los tumores malignos de ovario. En la actualidad, y pese a que el concepto de tumor de Krukenberg ha sido usado para referirse a todos los tumores metastásicos del ovario, se consideran como tal a los que tienen un origen digestivo. Su pronóstico es malo con raras supervivencias más allá del año. Se presenta un caso de una paciente femenina de 38 años de edad, que ingresa por ascitis moderada, anorexia y pérdida de peso, a la cual se le realizó una laparotomía con el posible diagnóstico de un proceso oncoproliferativo del ovario y el diagnóstico histopatológico arrojó un tumor de Krukenberg

Krukenberg's tumor accounts for 30-40 percent of ovarian metastatic cancer and for the 1-2 percent of all ovarian malignant tumors. Nowadays and in spite of the fact that the concept of Krukenberg' tumor has been used to refer to all ovarian metastatic tumors those with a digestive origin, its prognosis if bad with only a few survivals beyond one year. This is the case of a female patient aged 38 admitted due to a moderate ascites, anorexia and lose weight undergoes laparotomy with the possible diagnosis of a oncoproliferous ovarian process and the histopathological diagnosis showed a Krukenberg's tumor

Metachronous Ovarian Metastases Following Resection of the Primary Gastric Cancer

PURPOSE: We performed this study to evaluate the clinical presentation as well as the proper surgical intervention for ovarian metastasis from gastric cancers and these tumors were identified during postoperative follow-up. This will help establish the optimal strategy for improving the survival of patients with this entity. MATERIALS AND METHODS: 22 patients (3.2%) with ovarian metastasis were noted when performing a retrospective chart review of (693) females patients who had undergone a resection for gastric cancer between 1981 and 2008. The covariates used for the survival analysis were the patient age at the time of ovarian relapse, the size of the tumor, the initial TNM stage of the gastric cancer, the interval to metastasis and the presence of gross residual disease after treatment for Krukenberg tumor. The cumulative survival curves for the patient groups were calculated with the Kaplan-Meier method and they were compared by means of the Log-Rank test. RESULTS: The average age of the patients was 48.6 years (range: 24 to 78 years) and the average survival time of the 22 patients was 18.8 months (the estimated 3-year survival rate was 15.8%) with a range of 2 to 59 months after the diagnosis of Krukenberg tumor. The survival rate for patients without gross residual disease was longer than that of the patients with gross residual disease (P=0.0003). In contrast, patient age, the size of ovarian tumor, the initial stage of gastric adenocarcinoma, the interval to metastasis and adjuvant chemotherapy were not prognostic indicators for survival after the development of ovarian metastasis. CONCLUSIONS: Early diagnosis and complete resection are the only possible hope to improve survival. As the 3-year survival rate after resection of Krukenberg tumor is 15.8%, it seems worthwhile to consider performing tumorectomy as the second cytoreduction.

Metástasis de carcinoma de estómago que simula cáncer primario de ovario: importancia de la biopsia por congelación / Metastasis of carcinoma of stomach cancer simulating primary ovarian tumor: importance of frozen biopsies

Objetivo: Importancia de la Bíopsia por congelación en el diagnóstico y manejo de las pacientes con tumores de ovario. Resultados: Comunicamos nueve casos de pacientes con tumores de ovario.El carcinoma primario se encontró durante la operación programada para resección del tumor de ovario.En estos casos durante el acto operatorio y por la biopsia por congelación se hizo diagnóstico de tumor de krukenberg y el carcinoma primario se encontró en el estómago. Conclusiones: El resultado del estudio de nueve pacientes con carcinoma gástrico que simulaba cancer primario de ovario, muestra la importancia de la biopsia por congelación y la comunicación con los médicos cirujanos durante el acto operatorio.

Objetive: The importance of frozen section in the Diagnosis and manegment of patients with ovarian tumors. Results: We report 9 cases of patients with ovary tumors. The primary carcinoma was found during an operation for the ovarian tumor. In these cases the diagnosis of krukenberg tumor was made intraoperatively by frozen section evaluation and the primary carcinoma were found in the stomach. Conclusions: The results of the study of 9 patients with metástasis from gastric carcinoma simulating primary carcinoma of the ovary show us the importance of frozen section and the comunication with the surgeon intraoperatively.

Peritonitis esclerosante: presentación de tres casos / Sclerosing peritonitis: presentation of thre cases

Se presenta tres casos de peritonitis esclerosante, dos de ellos relacionados con adenocarcinoma gástrico y un tercero asociado con tecoma. El cuadro clínico fue el de dolor abdominal, ascitis y obstrucción intestinal.

It is shown three cases of sclerosing peritonitis, two of them related to gastricadenocarcinoma and the other one associated to thecoma. The clinical picture comprised abdominal pain, ascites and intestinal occlusion.

retrospective study of ovarian tumours and tumour-like lesions

Ovaries are common site of non-neoplastic and neoplastic lesions. They can present from the neonatal period to post menopause. Most are functional in nature and resolve with minimal treatment. Objective of the study was to determine the nature of various ovarian lesions and to ascertain the frequency and distribution of the various non-neoplastic and neoplastic lesions. The study was a retrospective review of all cases of ovarian cancer, benign ovarian neoplasm and functional ovarian cysts received during Jan-Dec 2008 at Chughtai's Lahore Laboratory. The clinical data of the patients was obtained from their respective files. A total of 498 different non-neoplastic and neoplastic lesions were seen during one calendar year 2008. Non-neoplastic cysts were more common [343, 68.87%] than neoplastic tumours [155, 31.12%]. The commonest non-neoplastic cyst was luteal cyst followed by follicular cyst. Among the neoplastic tumours 78.70% were benign and 21.29% were malignant. Benign serous cysts were the commonest benign tumour followed by mature cystic teratoma and mucinous cyst. Serous cystadenocarcinoma was the commonest malignant tumour followed closely by endometrioid carcinoma and granulosa cell tumour. Krukenberg tumour, tumour metastatic to ovaries and non-Hodgkins lymphoma was also diagnosed during this period. Malignant germ cell tumours were seen in much younger age group followed by sex cord stromal tumours. Epithelial tumours were seen in much older age group. The morphologic diversity of ovarian masses poses many challenges. A specific diagnosis can usually be made by evaluating routinely stained slides but sometimes immunohistochemistry is required in difficult cases. Gross features also provide useful diagnostic clues

Utility of Surgical Resection in the Management of Metachronous Krukenberg's Tumors of Gastric Origin

PURPOSE: The aim of this study was to determine the prognostic factors and the significance of metastatectomy for Krukenberg's tumors of gastric origin. MATERIALS AND METHODS: Among the patient who underwent gastric surgery from 1992 through 2005, 90 female patients with Krukenberg's tumors of gastric origin were identified. We retrospectively reviewed the clinicopathologic characteristics, prognostic factors, and treatments for primary gastric cancer. We also investigated the prognostic risk factors for the onset of metachronous Krukenberg's tumors and the survival time of patients who underwent an operation for metachronous Krukenberg's tumors. RESULTS: The presence of a synchronous Krukenberg's tumor (mean survival time=17.6 months, P<0.01), peritoneal seeding (14.5 months, P<0.01), and non-curative resection (15.1 months, P<0.01), were statistically significant prognostic factors for survival time in female patients with gastric cancer. The stage of primary gastric cancer (P=0.049) and lymph node metastasis (P=0.011) were statistically significant risk factors for recurrence time of a metachronous Krukenberg's tumor. In the metachronous Krukenberg's tumor group (n=53), the mean survival time of the metastatectomy group (n=46, 43.2 months, P=0.012) was longer than that in the chemotherapy or conservative treatment groups (n=7 and 24 months, respectively). Metastatectomy, presense or abscence of residual tumor and extent of residual tumor were significant prognostic factors for survival time in female patients with metachronous Krukenberg's tumor of gastric origin. CONCLUSIONS: A close observation and evaluation with ultrasound or computed tomography is necessary in female patients with advanced gastric cancer to detect a metachronous Krukenberg's tumor as soon as possible. The surgeon must operate more aggressively in patients with metachronous Krukenberg's tumors.