A Krukenberg Tumor from an Occult Intramucosal Gastric Carcinoma Identified during an Autopsy.
A healthy 45-year-old Japanese female developed right pleural effusion, ascites, and a pelvic mass. Bilateral salpingo-oophorectomy resolved the pleural effusion and ascites. Histopathological examination of the ovaries showed bilateral Krukenberg tumors with signet-ring cell carcinoma (SRCC). Extensive testing including upper and lower gastrointestinal endoscopy and whole-body imaging did not detect the primary lesion. Six months after bilateral salpingo-oophorectomy, the patient developed multiple osteoblastic bone lesions in the spine, pelvis, and femurs. A biopsy of the bone marrow showed SRCC. We administered four cycles of S-1 and cisplatin, resulting in the shrinkage of osteoblastic lesions; she remained stable for a year. Then, she developed disseminated intravascular coagulation with disease progression in the bones. Although she was treated with paclitaxel, the disseminated intravascular coagulation progressed, and she died in a month. During the autopsy, microscopic examination revealed four foci of intramucosal gastric SRCC and healthy macroscopic gastric mucosa.
Department of Oncology, Kameda Medical Center, Kamogawa, Chiba 296-8602, Japan ; Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan.
Yoshiaki
0000-0002-5241-6855
Y
Nakamura
Department of Oncology, Kameda Medical Center, Kamogawa, Chiba 296-8602, Japan.
Ayako
A
Hiramatsu
Department of Oncology, Kameda Medical Center, Kamogawa, Chiba 296-8602, Japan.
Takafumi
0000-0002-2791-5572
T
Koyama
Department of Oncology, Kameda Medical Center, Kamogawa, Chiba 296-8602, Japan.
Yu
Y
Oyama
Department of Gynecology, Kameda Medical Center, Kamogawa, Chiba 296-8602, Japan.
Ayuko
A
Tanaka
Department of Anatomic and Diagnostic Pathology, Dokkyo Medical University School of Medicine, Shimotsuga, Tochigi 321-0293, Japan.
Koichi
K
Honma