Managementul perioperator al unui pacient cu tumoră Krukenberg - studiu de caz

Ovarian cancer metastatic prognosis

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.

[Liver metastases with unknown primary site].

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 cancer metastatic prognosis tumors comprise a heterogeneous group of lesions, displaying distinct tumor pathology and oncogenic 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 ovarian cancer metastatic prognosis metastases of mucin-secreting signet ring cell cancer, arising primarily from the 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.

Perioperative management of a patient with Krukenberg tumor - a case report

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 ovarian cancer metastatic prognosis 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 ovarian cancer metastatic prognosis 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 ovarian cancer metastatic prognosis 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.

Managementul perioperator al unui pacient cu tumoră Krukenberg - studiu de caz

Cancer renal gpc 2019 was diagnosed with bilateral ovarian cysts for which reevaluation was recommended. 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.

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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.

CA tumor markers were recommended.

ovarian cancer metastatic prognosis

The local clinical examination revealed 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.

The patient was admitted in the hospital for reevaluation and for establishing the therapeutic conduct. We performed a new transvaginal ultrasound which ovarian cancer metastatic prognosis the same aspects, except for increased peritoneal fluid 30 mm in the recto-uterine pounch - Cancerul de piele da metastaze 1 and Figure 2.

Overexpression of Bmi-1 has been reported in various human cancers and proved to be associated with poor survival. Disscusion: Bmi-1 is expressed by various tumors and therefore may contribute to malignant transformation. Bmi-1 not only can lead mammary epithelial cells to senescence and immortalization, but also plays a key role in breast cancer. A significant correlation was observed between Bmi-1 expression and axillary lymph node metastases in lymph-ductal breast cancer.

Figure 1. Tumoral transformation of the right ovary; non-homogenous structure, predominantly tisular Figure 2. Figure 3.

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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.

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General ovarian cancer metastatic prognosis consultation was requested to exclude a sub-occlusive syndrome, followed by upper ovarian cancer metastatic prognosis which showed a normal aspect, with the exception of enlarged folds in the vertical portion of the stomach, but which distended fully under insufflation.

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.

We detected 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. ovarian cancer metastatic prognosis

Managementul perioperator al unui pacient cu tumoră Krukenberg - studiu de caz

A - The macroscopic aspect of the ovarian cancer metastatic prognosis 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 total hysterectomy with bilateral oophorectomy, with the piece being sent to histopathological examination histopathological extemporaneous examination showed undifferentiated ovarian ovarian cancer metastatic prognosis 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 to follow the specialized treatment after receiving the final histopathological result. After 4 days she returned to the Emergency Room for epigastric pain, 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. Intraoperatively, we found an early adherence syndrome.

After an extensive histopathological analysis which included multiple immunohistochemistry tests, the diagnosis of Krukenberg tumors was established Figure 6. Figure 6. Histopathological analysis The postoperative evolution was favorable, with improvement of digestive symptomatology; the patient will perform other specialized investigation echo-endoscopy and she was guided to the Oncology Department for specific postoperative treatment. Discussions Krukenberg tumor is an uncommon metastatic adenocarcinoma of ovaries arising primarily from the gastric carcinoma, which may cause diagnostic confusion with primary ovarian tumors ovarian cancer metastatic prognosis.

ovarian cancer metastatic prognosis

Although he proposed it as a primary tumor of ovary, later it was proved to be secondary ovarian cancer metastatic prognosis gastrointestinal tract malignancy 4.

Ovaries affected by these tumors retains its shape, irrespective of the size 3.

[Liver metastases with unknown primary site].

Our case sustains the bilateral feature of the tumors, with tumoral sizes described in literature. Transabdominal sonography of abdomen and pelvis is the primary imaging and screening modality for females with gynecological complaints. The ultrasound examination of patients with Krukenberg tumors shows varied echogenicity ranging from purely solid to purely cystic.

In contrast with the primary ovarian tumors in which criteria used to describe the ovarian malignancy irregular solid tumor, ascites, at least 4 papillary structures, multi-loculated solid tumor with the largest diameter over mm and the presence of increased Doppler flowmost frequently, Krukenberg tumors will be homogenously hyperechoic solid masses with few ovarian cancer metastatic prognosis within.

There will doare cancerul mamar large lead vessel penetrating the mass from the periphery and nourishing the tumour by branching in tree pattern, known as lead vessel sign, with high speed and low resistance on spectral Doppler 3,11, During the histopathological analysis, these tumors are characterized by the presence of signet ring cells and pseudo-sarcoma proliferation ovarian cancer metastatic prognosis ovarian stroma Immunohistochemical tests have a large impact on the diagnostic of ovarian carcinomas, by providing useful assessment criteria for a better reproducibility of cell type diagnosis For a good differentiation of the histological subtype and for assessing tumor aggressiveness, it is necessary to conduct immunohistochemical tests, which commonly target the expression of proliferation markers and aggression CK7, WT1, p53 and ki67 We conducted an extensive histopathological examination and also performed multiple immunohistochemistry tests in order to establish the final diagnosis of Krukenberg tumor.