Discovery of Asymptomatic Krukenberg Tumors Diagnosed During Caesarean Section: Therapy With Hyperthermic Intraperitoneal Chemotherapy

Abstract

We report a case of the discovery of asymptomatic Krukenberg tumors in a 37-year-old woman in the 37th week of pregnancy during caesarean section. Subsequent gastroscopy revealed an adenocarcinoma of the stomach as the primary tumor site. The patient was treated with hyperthermic intraperitoneal chemotherapy (HIPEC). Tumor surgery (Partial parietal peritonectomy and partial gastrectomy) and HIPEC treatment were successful, with no complications found during follow-up. Use of HIPEC seems to be a promising option after radical surgery, including its use in patients with gastric tumors that are in advanced stages, and use in patients who have tumors with poor prognoses, such as Krukenberg tumors.

Pregnancy complicated by a Krukenberg tumor with an undetermined origin and its management

“…Recently, co‐administration of hyperthermic i.p. chemotherapy with cytoreductive surgery for Krukenberg tumors with a gastric origin was suggested as a promising option by some authors . On the other hand, the inability to demonstrate the primary tumor with the most current sophisticated diagnostic tools and recurrent laparotomies, and also inconsistencies in immunological stains, still prevent us from eliminating the possibility of a primary Krukenberg tumor.…”

“…Krukenberg tumors are extremely rare in pregnancy. Only eight cases have been reported within the last 5 years in the published work . Herein, we present a nulliparous patient at 29 weeks of pregnancy admitted with premature labor and revealed to have a Krukenberg tumor with undetermined primary origin.…”

Clinicopathological features and maternal and foetal management of pregnancy‑complicating Krukenberg tumours

“…Regular anti-tumour therapies, the most common of which is intravenous chemotherapy, should be performed after surgery. Notably, an uneventful treated case of a pregnancy-complicating Krukenberg tumour that was managed with intraperitoneal chemotherapy after caesarean section has been reported (29). For patients whose gestational times are close to the gestational age at which a viable preterm infant can be delivered and who strongly wish to continue their pregnancies, doctors may provide personalized treatment after a comprehensive assessment of the disease status, the patient's general condition, her willingness to continue the pregnancy, and the level of paediatric medical support.…”

A review on pregnancy complicated by ovarian epithelial and non-epithelial malignant tumors: Diagnostic and therapeutic perspectives

“…Intraperitoneal chemotherapy has not been widely adopted in pregnant women [58] , due to significant toxicity and poor treatment completion rates [83] . However, an uneventful treated case with Krukenberg tumour managed with HIPEC after caesarian section was reported [84] . The effect of HIPEC on fertility is unknown as the available information is limited; however, seven spontaneous pregnancies following treatment with HIPEC have been described in a case series of patients diagnosed with metastatic colon cancer [85] .…”

“…Sex hormones during pregnancy, promote the development and diffusion of gastric cancer by stimulating the underlying precancerous lesions. Placental growth factor levels have been determined to be much higher than vascular endothelial growth factor levels in gastric cancer tissue, and were also associated with serosal invasion, lymph node metastasis, cancer stage, and survival rates [84] .…”