Secondary amenorrhea as the first presentation of Krukenberg tumor arising from the gastroesophageal junction in a 34-year-old woman: A case report.

INTRODUCTION: Krukenberg tumors account for 9 % of metastatic ovarian tumors, they usually originate from the stomach and colon and are microscopically characterized by the presence of mucus-filled signet-ring cells. Krukenberg tumor originating from the gastroesophageal junction is extremely rare, which limits establishing proper diagnosis and management. PRESENTATION OF CASE: A 34-year-old women presented with a complaint of amenorrhea, ultrasonography showed bilateral ovarian masses, pathological studies revealed Krukenberg tumor, immunohistochemistry of the tumor was positive for (CK1, and CK20). Upper GI endoscopy revealed the primary lesion located at the inferior esophagus and extending to the cardia. Despite marked improvement after introducing a chemotherapy regimen of oxaliplatin, calcium folinate and fluorouracil, the patient refused to complete her therapeutic course and died 5 months after discontinuation. DISCUSSION: Krukenberg tumor may be asymptomatic but may also manifest as pelvic pain, bloating, and menstrual cycle abnormalities. Immunohistochemistry of Krukenberg tumor is mandatory to determine the primary tumor. Positivity of CK1, CK20 and negativity of CK7 indicates the gastrointestinal origin of the tumor. Different choices are available for the management of Krukenberg tumor but it still has a poor prognosis with an average survival rate of 14 months. CONCLUSION: Krukenberg tumor from the esophagus is rare and still enigmatic in terms of management. In this article, we aim to draw attention into possible presentations of the tumor by providing the first case in Syria of Krukenberg tumor originating from the esophagus and presenting as secondary amenorrhea and bilateral adnexal masses.

Symptomatic H- type gallbladder in a male patient: A rare case report from Syria.

Introduction and importance: Double gallbladders are a rare anomaly occur in biliary system during the fetal life. In most cases they are asymptomatic, but in few patients, they can progress as a sever disease. Preoperative diagnose is essential in order to prevent surgery complexities and prevent the undesired complications. Case presentation: We described a typical case of symptomatic duplicate gallbladder in a 42-year-old man who suffered from chronic abdominal symptoms without determining the cause. The accessory gallbladder was discovered by imagining screening tools which included ultrasound and magnetic resonance cholangiopancreatography and was treated successfully with laparoscopic cholecystectomy, where both gallbladders were removed without any complications. Clinical discussion: Double gallbladder are rare abnormality occur in fetal life during the fifth and sixth weeks of pregnancy. In most cases they show zero symptoms and can be easily wandered off during typical preoperative screening. Therefor many diagnostic tools were developed to investigate this anomaly in order to prevent its unwanted outcomes and to help the surgeon in deciding the best surgical approach for each presenting case. Conclusion: In order to prevent complications during surgery, it is vital that we investigate the presence of a double gallbladder in a surgical patient before the procedure.