J Gastric Cancer.  2014 Dec;14(4):275-278. 10.5230/jgc.2014.14.4.275.

Gastric Cancer Presenting as a Krukenberg Tumor at 22 Weeks' Gestation

Affiliations
  • 1Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA. paul_vincent_co@hotmail.com
  • 2Department of Medicine, Rush University Medical Center, Chicago, IL, USA.

Abstract

Gastric cancer is rare during pregnancy, and often advanced upon presentation. A Krukenberg tumor presents a diagnostic and therapeutic challenge in the pregnant patient. We present a case of a 38-year-old woman at 22 weeks' gestation who presented with worsening epigastric pain, and was found to have a left pelvic mass on ultrasound, which was confirmed by magnetic resonance imaging. She went into active labor and delivered a viable infant via vaginal delivery. An exploratory laparotomy revealed a large mass originating from her left ovary and diffuse thickening of the lesser curvature of the stomach. Frozen section investigation revealed the presence of signet cell adenocarcinoma. Subsequent upper endoscopy showed linitis plastica, while biopsy confirmed the presence of adenocarcinoma. In conclusion, the occurrence of gastric cancer in pregnancy is rare despite extremely common symptoms. The management poses a challenge because of the need for early treatment, and the continuation of the pregnancy.

Keyword

Krukenberg tumor; Stomach neoplasms; Pregnancy; Linitis plastica

MeSH Terms

Adenocarcinoma
Adult
Biopsy
Endoscopy
Female
Frozen Sections
Humans
Infant
Krukenberg Tumor*
Laparotomy
Linitis Plastica
Magnetic Resonance Imaging
Ovary
Pregnancy*
Stomach
Stomach Neoplasms*
Ultrasonography

Figure

  • Fig. 1 Ultrasound showing intrauterine pregnancy.

  • Fig. 2 Ultrasound showing left adnexal mass of heterogenous echodensity measuring around 13.4 cm in the largest diameter which was separate from the uterine mass.

  • Fig. 3 Magnetic resonance imaging showed large pelvic mass arising from the left adnexa, ascites and demonstrated edema of the mesentery and omentum.

  • Fig. 4 Ovarian tissue showing signet cell adenocarcinoma (mucicarmine stain positive, ×40).

  • Fig. 5 Esophagogastroduodenoscopy showing linitis plastica and multiple gastric erosions.


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