A Krukenberg tumor in a young patient / Tumor de Krukenberg en paciente joven

Abstract A Krukenberg tumor (KT) is a rare secondary ovarian tumor which occurs in approximately 1-2% of all ovarian tumors. In most cases, it is secondary to a primary gastrointestinal tract tumor, especially of the stomach, colon or rectum 1. The mean age of women diagnosed with KT ranges from 40 to 46 years, while 35 to 45% are under 40 2. In this report, we describe the clinical case of a 23-year-old woman who consulted due to epigastric pain, adynamia, decreased appetite, and vaginal bleeding. She underwent an abdominal-pelvic CT which reported findings compatible with an anthro-pyloric cancer with signs of angiogenesis and adenopathies in the greater and lesser curvature, with a metastatic appearance, as well as solid material hanging from the pelvic visceral peritoneum, in close contact with the ovaries. Subsequently, a gastric endoscopy with biopsy was performed which reported gastric adenocarcinoma with signet ring cells, as well as peritoneal and ovarian involvement and positive CA25-5 and CA19-9 markers. She was given palliative chemotherapy, but developed a constitutional syndrome requiring treatment by internal medicine to improve her condition enough to continue chemotherapy. After approximately one month of a sluggish course, the patient died on March 15, 2021, due to bradycardia and hypotension. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2736).

Resumen El tumor de Krukenberg (TK) es una neoplasia ovárica secundaria poco frecuente, que se presenta aproximadamente en 1- 2% de la población de todos los tumores en ovario, en la mayoría de los casos secundario a un tumor primario del tracto gastroentérico, en particular del estómago, colon o recto 1. La edad media de las mujeres diagnosticadas con TK oscila entre 40 y 46 años, mientras que entre 35 y 45% son menores de 40 años 2. En este reporte se describe el caso clínico de una mujer de 23 años quien consulta con un cuadro de epigastralgia, adinamia, hiporexia y sangrado vaginal, quien se le realizó TC abdomino-pélvico que reportó hallazgos compatibles con neoplasia antropi-lórica con signos de angiogénesis y adenopatías en curvatura mayor y menor de aspecto metastásico en estómago, además de material solido dependiente del peritoneo visceral en pelvis, en íntimo contacto con los ovarios. Posteriormente se le realizó endoscopia gástrica con biopsia en donde se reportó adenocarcinoma gástrico con células en anillo de sello, además de compromiso peritoneal y compromiso de ovario y marcadores CA25-5 y CA19-9 positivos. Se le dio manejo de quimioterapia paliativa, sin embargo la paciente presentó un síndrome constitucional por lo que requirió manejo en el servicio de Medicina Interna, hasta estar en mejores condiciones para continuar con tratamiento de quimioterapia. Al cabo de aproximadamente un mes de evolución tórpida, el 15 de marzo de 2021 la paciente fallece previo cuadro de bradicardia e hipotensión. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2736).

Comparison of 68Ga-FAPI and 18F-FDG PET/CT for the diagnosis of primary and metastatic gastric signet-ring cell carcinoma / 中华核医学与分子影像杂志

Objective:To investigate the clinical utility of 68Ga-labeled fibroblast activation protein inhibitor (FAPI) PET/CT in the detection of primary and metastatic gastric signet-ring cell carcinoma (GSRCC) and compared the results with those of 18F-FDG PET/CT. Methods:A total of 21 patients (10 males, 11 females, average age 52 years) with primary and metastatic GSRCC who underwent 68Ga-FAPI and 18F-FDG PET/CT at the First Affiliated Hospital of Xiamen University from June 2020 to May 2022 were retrospectively analyzed. Pathological results of surgery and (or) biopsy were used as the " gold standard" for final diagnosis. In cases whose surgery or tissue biopsies were not available, clinical and radiographic follow-up results were used as the reference standards. Wilcoxon signed-rank test was used to compare the SUV max of 18F-FDG and 68Ga-FAPI. McNemar χ2 test was used to compare the detection rate between 18F-FDG and 68Ga-FAPI PET/CT. Results:68Ga-FAPI PET/CT showed higher SUV max than 18F-FDG in primary tumors (5.3(2.4, 15.7) vs 2.4(1.8, 2.5); z=2.31, P=0.021), local recurrences (7.8(6.0, 8.9) vs 2.4(1.9, 3.4); z=2.20, P=0.028), lymph nodes metastases (7.7(4.5, 12.2) vs 2.4(1.9, 3.6); z=6.01, P<0.001) and bone/visceral metastases (6.7(5.3, 11.1) vs 2.4(2.0, 3.4); z=11.36, P<0.001). Regarding diagnostic accuracy, 68Ga-FAPI PET/CT showed higher sensitivities than 18F-FDG for primary tumors (7/9 vs 2/9; χ2=3.20, P=0.063) and local recurrences (7/7 vs 2/7; χ2=3.20, P=0.063). It also demonstrated higher lesion detection rates than 18F-FDG for suspicious lymph node metastases (86%(65/76) vs 32%(24/76); χ2=31.37, P<0.001) and bone/visceral metastases (99%(184/185) vs 39%(73/185); χ2=107.08, P<0.001). Conclusions:68Ga-FAPI PET/CT showed higher tumor uptake and lesion detection rate than 18F-FDG in the primary and metastatic GSRCC. 68Ga-FAPI PET/CT demonstrates good diagnostic performance for tumor detection, staging, and restaging of GSRCC, which is helpful to further guide clinical treatment strategy.

Estenosis gastroduodenal: una complicación infrecuente del carcinoma gástrico de células en anillo de sello / Upper gastrointestinal stenosis: a rare complication of gastric-signet ring cell carcinoma / Estenose gastroduodenal: uma complicação rara do carcinoma gástrico de células em anel de sinete

El carcinoma de células en anillo de sello es una variante histopatológica de cáncer gástrico que se encuentra en aumento, se caracteriza por un mal pronóstico. Se presenta el caso de un hombre joven al que se le hizo este diagnóstico en el contexto de una complicación rara como es el síndrome de estenosis gastroduodenal.

Signet ring cell carcinoma is a histopathological variant of gastric cancer that is increasing and is characterized by a poor prognosis. We present the case of a young man who underwent this diagnosis in the context of a rare complication such as upper gastrointestinal stenosis syndrome.

O carcinoma de células em anel de sinete é uma variante histopatológica do câncer gástrico que está aumentando e é caracterizado por um mau prognóstico. É apresentado o caso de um jovem que recebeu este diagnóstico no contexto de uma complicação rara como a síndrome de estenose gastroduodenal.

Mieloptisis y cáncer gástrico: Una asociación infrecuente / Myelophthisis and gastric cancer. An unusual association

Se denomina mieloptisis a la infiltración de la médula ósea por células no hematopoyéticas. En pacientes con cáncer gástrico esta invasión es extremadamente infrecuente y la supervivencia suele ser menor a tres meses. Presentamos el caso de un hombre de 35 años con compromiso de la médula ósea secundario a un carcinoma gástrico difuso de células en anillo de sello.

The infiltration of the bone marrow y non-hematopoietic cells is called myelophthisis. In patients with gastric cancer, this invasion is extremely infrequent and the survival is usually less than three months. We present the case of a 35-year-old man with bone marrow involvement secondary to diffuse gastric carcinoma of signet ring cells.

Clinicopathlogic features and prognosis of the gastric signet ring cell carcinoma: a SEER database analysis / 医学研究生学报

Objective　Prognoses of late stage signet-ring cell carcinoma (SRCC) is usually worse than that in other gastric carcinoma. In the current study, SEER database were adopted to analyze the clinicopathologic features and prognoses of SRCC and non-signet-ring cell carcinoma (non SRCC), and to compare the differences in survival rate under different early treatments.　Methods　Clinical data of 5193 patients who were diagnosed with gastric carcinoma from 2010 to 2015 are collected from SEER. Patients are divided into two groups SRCC (n=2439) and non SRCC (n=2754) based on their histologic type. Differences in Gender, age, race, primary site, degree of differentiation, tumor size, depth of invasion, local lymph node metastasis, distant metastasis, tumor, node, metastasis (TNM) staging, operative treatment and chemotherapy were compared. Cox regression model was used to analyze prognostic factors. According to different operative treatment, patients in SRCC and non SRCC groups were divided into surgery group and surgery with adjuvant chemotherapy group, respectively. Kaplan-meier method was used to draw the survival curve, and Log-Rank test was adopted for survival analysis.　Results　Significant statistical difference (P<0.05) were found in the two gastric carcinoma groups regarding gender, age, race, primary site, degree of differentiation, tumor size, depth of invasion, local lymph node metastasis, distant metastasis, TNM staging, operative treatment and chemotherapy. The multivariate Cox regression analysis indicated that age (HR:1.417; 95%CI:1.273-1.578; P<0.05), race (HR:0.91; 95%CI:0.825-0.998; P<0.05), tumor size (HR:1.28; 95%CI: 1.199-1.365; P<0.05), depth of invasion (HR: 1.252: 95%CI: 1.159-1.352; P<0.05), local lymph node metastasis (HR:0.862; 95%CI: 0.81-0.918; P<0.05), distant metastasis (HR: 1.369: 95%CI: 1.069-1.753; P<0.05), TNM stage (HR:1.342; 95%CI:1.155-1.559; P<0.05), and surgical treatment (HR:0.245; 95%CI: 0.228-0.284; P<0.05) are independent risk factors affecting the prognosis of SRCC patients. The overall five-year survival rate of SRCC patients is 27.6% , which is lower than that of non SRCC patients (43.0%). Therefore, there is significant difference in statistics (P<0.05). Significant statistical difference was also found in stratification analysis of the five-year survival rates among SRCC surgery group, SRCC surgery with adjuvant chemotherapy group, non SRCC surgery group and non SRCC surgery with adjuvant chemotherapy group. The results indicated that the five-year survival rates of SRCC surgery with adjuvant chemotherapy group at stage TIN1M0 and stage T2N0M0 are both superior to that in the surgery group with statistical difference (P<0.05). In addition, the five-year survival rate of SRCC surgery with adjuvant chemotherapy group at T2N0M0 is superior to that in the non SRCC patients, with statistical difference (P<0.05).　Conclusion　SRCC patients present with unique clinicopathologic features. Early detection and treatment could improve the prognosis of SRCC patients.

Prognostic Impact of Microsatellite Instability in Colorectal Cancer Presenting With Mucinous, Signet-Ring, and Poorly Differentiated Cells

PURPOSE: Mucinous cells (MUCs), signet-ring cells (SRCs), and poorly differentiated cells (PDCs) are uncommon histologic types and have been associated with advanced tumor stage and poor prognosis. However, MUCs, SRCs, and PDCs are commonly observed in cancers with high microsatellite instability (MSI), which have favorable outcomes compared with cancers with microsatellite stability (MSS). The purpose of this study was to evaluate the prognostic impact of high-MSI in patients with sporadic colorectal cancer presenting with MUCs, SRCs, and/or PDCs. METHODS: Between January 2006 and December 2012, 176 with proven microsatellite status who also presented with MUCs, SRCs, and PDCs were selected for this study and were divided into 2 groups, high-MSI and MSS; their outcomes were analyzed. RESULTS: Of the 176 patients, 56 and 120, respectively, had high-MSI and MSS cancers. High-MSI cancers had larger tumors, proximal tumor location, and a lower TNM stage. The recurrence rate was lower in the high-MSI group (13.7% vs. 35.4%, P = 0.006). Common patterns of distant metastasis for MUC, SRC, PDC cancers were peritoneal spread (46.9%) and hematogenous metastasis (46.4%). The 5-year CSS rates were 88.2% and 61.2% for patients with high-MSI and MSS cancers, respectively (P < 0.0001). In the multivariate analysis, except for stage-IV cancer, MSI status was an independent risk factor for cancer-specific survival (MSS: hazard ratio, 4.34; 95% confidence interval, 1.68-11.21). CONCLUSION: In patients with colorectal cancer presenting with MUCs, SRCs, and/or PDCs, those with high-MSI cancers had better outcomes.

Bilateral Krukenberg Tumor.

Adrenal Myelolipoma is a rare tumor that is benign in nature and unilateral. It is usually asymptomatic with just a few millimeters in size but they can grow over 30 cms becoming a life threat to the patient. This tumor is generally considered as a type of hormonally inactive neoplasm which is composed of variable amounts of mature adipose tissue and normal hematopoeitic elements. These may not account for extramedullary sites of haemotopoiesis and are not associated with any specific hematologic disorder. Rarely, Adrenal Myelolipomas occur in association with Adrenocortical Adenoma or Adrenocortical Carcinoma. We report a case of Adrenocotical Adenoma with Myelolipoma in a 35 year old female who presented with pain in the right upper abdomen. The radiological appearance resembled adrenocortical carcinoma. This case emphasize the importance of this combination as a pitfall in the correct diagnosis and management of patient with Adrenal mass.

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.

Benign signet ring cells in pseudomembranous colitis: A diagnostic trap.

A 71-year-old female patient was admitted with intractable diarrhea and abdominal distention following several courses of broad spectrum antibiotic therapy. Colonic biopsy revealed pseudomembranous colitis with foci of signet ring cell (SRC) change. The SRCs possessed bland nuclei and were confi ned to the basement membranes of the crypts with no infi ltration into the lamina propria. Benign SRCs in pseudomembranous colitis is an uncommon phenomenon. Awareness of this rare, but potential pitfall is of utmost importance to avoid a misdiagnosis of SRC carcinoma.

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.

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

Adenocarcinoma mucinoso pulmonar con patrón de células en anillo de sello: una entidad infrecuente / Mucinous adenocarcinoma of the lung with signet-ring cell pattern: an infrequent entity

El adenocarcinoma mucinoso de pulmón con patrón de células en anillo de sello es una entidad infrecuente de diagnóstico fácil. Presentamos el caso de un paciente de 55 años con antecedente de cardiopatía isquémica y diagnóstico actual de adenocarcinoma primario pulmonar con patrón de células en anillo de sello. Es necesario descartar un origen primario extrapulmonar, principalmente de localización digestiva. Las técnicas inmunohistoquímicas son de gran utilidad a la hora de establecer diagnósticos diferenciales.

Mucinous adenocarcinoma of the lung with signet-ring cell pattern is an infrequent entity of easy diagnosis. We report the case of a 55 year-old patient with preexisting ischemic heart disease and recent diagnosis of pulmonary adenocarcinoma with signet-ring cell pattern. It is necessary discard a primary extrapulmonar location (digestive tract). Immunohistochemistry is a useful tool in the differential diagnosis.