Early gastric cancer with Krukenberg tumor and review of cases of intramucosal gastric cancers with Krukenberg tumor

Abstract

A 47-year-old woman was admitted because of hypermenorrhea. Transvaginal ultrasonography revealed an ovarian tumor and myoma uteri, and total hysterectomy with bilateral salpingo-oophorectomy was performed. Histology revealed signet-ring cell carcinoma in the right ovary. In order to find out the primary site of this tumor, gastroendoscopy was performed after the operation, and showed a IIc lesion in the lower body of the stomach; biopsy specimens showed signet-ring cell carcinoma similar to that in the right ovary. Total gastrectomy revealed that the lesion was an early gastric cancer confined to the mucosa, but there was lymphatic invasion slightly beneath the muscularis mucosa, with regional lymph node metastasis. In the light of a review of the seven cases of early gastric cancer with Krukenberg tumor previously reported, lymphatic metastasis seemed to be the most likely pathway of ovarian metastasis in early gastric cancers.

Non-Hodgkin lymphoma involving stomach and ovary: extending the Krukenberg tumor concept

“…In the years following Krukenberg's original report, it became clear that these tumors are in fact adenocarcinomas involving one or both ovaries, and are almost invariably secondary to carcinomas of the stomach or intestines [2]. The ovarian tumor may become clinically manifest before the gastric primary, which often escapes diagnosis due to its small size [3,4]. The mode of tumor spread from stomach to ovaries without involvement of other tissues has intrigued pathologists for a long time.…”

An Up-to-Date Understanding of the “Krukenberg Tumor” Mechanism

“…In many cases of Krukenberg tumor lymphatic permeation is microscopically noted at the hilum and cortex of the ovary. Review of literature for early gastric carcinoma by Kakushima N, Kamoshida T, Hirai S, et al reported 8 cases of KT where at primary gastric carcinoma cancer cells was only confined to mucosa and submucosa [23]. As we know there is a rich lymphatic plexus at the gastric mucosa and submucosa, the lymphatic spread in the above mentioned 8 cases of early gastric cancers couldthus be explained.…”

“…Also some studies have shown, when the number of metastatic lymph node in the case of gastric carcinoma is increased there is a higher risk of ovarian metastasis [24]. Atrophic gastritis has also been viewed as a risk factor of metastases because in the atrophic gastritis patients, lymphatic capillaries get closer to the mucosal surfacethus facilitating more easy infiltration of the intramucosal cancer cells into the lymphatic capillaries [23]. Yamanishi, Yukio, et al in their study stated the reason for lymphatic metastasis from stomach to the ovary as the lymphatic vessel anatomy.…”

“…They also concluded retrograde lymphatic spread to be the route of metastasis and the ovaries were among the first organs involved with such metastasis. Kakushima N et al [23] states in favor of lymphatic spread of KT. In ovarian hilum, ovarian cortex, mesoovarium and mesosalpinx there are large amount of lymphatic tissue where carcinomatous emboli are frequently observed in KT [23].…”

“…Kakushima N et al [23] states in favor of lymphatic spread of KT. In ovarian hilum, ovarian cortex, mesoovarium and mesosalpinx there are large amount of lymphatic tissue where carcinomatous emboli are frequently observed in KT [23]. Tazaki T et al had done a study to observe lymph vessel permeation in the ovarian hilum where they found all oftheir 10 cases had lymph vessel permeation by cancer cells at the ovarian hilum [26].…”