title: A patient with 43 synchronous early gastric carcinomas with a Krukenberg tumor and pericardial metastasis.
abstract: A 53-year-old Japanese woman with bilateral ovarian tumors consulted our department. Gastroendoscopy disclosed 16 superficial depressed gastric lesions, and the histopathological diagnosis of the biopsy specimens was poorly differentiated adenocarcinoma and signet-ring cell carcinoma. Computed tomography (CT), ultrasonography (US), and positron emission tomography (PET) examinations revealed no other metastasis except for that observed in the ovaries. We performed a total gastrectomy with radical lymph node dissection and bilateral ovarian resection. A postoperative histological examination revealed 43 isolated gastric lesions which were scattered over the entire resected stomach; they were all confined to the mucosa. Cancer cell invasion in the lymphatics was detected only in the submucosal region beneath the main tumor. Both ovarian tumors were diagnosed as metastasis of signet-ring cell carcinoma (Krukenberg tumor). Adjuvant chemotherapy with irinotecan (CPT-11) and low-dose cisplatin (CDDP) was given on an outpatient basis, but 1 year after the surgery, carcinomatous pericarditis occurred. Administration of mitomycin C (MMC) into the pericardial space was performed twice; however, unfortunately, the patient died 13 months after surgery.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Baba
authors.forename: Shinji
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Kouei
authors.initials: K
authors.lastname: Ikeda
authors.forename: Shinobu
authors.initials: S
authors.lastname: Honda
authors.forename: Nobutomo
authors.initials: N
authors.lastname: Miyanari
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Iyama
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D005743:Gastrectomy; D006338:Heart Neoplasms / Q000556:secondary*; D006801:Humans; D007725:Krukenberg Tumor / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D010496:Pericardium / Q000473:pathology*; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed