Case Report of Early Gastric Carcinoma after Surgery for Metastatic Ovarian Tumors

Abstract

Ovarian metastases from gastric carcinoma are often encountered clinically, while those from “early cancer” of the stomach are seen rarely, only six cases having been reported so far in Japan. The present case was that of a 33-year-old woman admitted for ovarian tumors incidentally noted at a routine medical checkup. Hysterectomy and bilateral adnexectomy were performed. Frozen sections were immediately examined, pathologically, and the Kruckenberg type of metastases was indicated. Even careful inspection and palpation throughout the abdominal cavity failed to disclose the primary site of malignancy. A UGI series and endoscopy conducted following recovery revealed a small carcinoma on the posterior gastric wall and gastrectomy with regional nodal dissection was subsequently performed. Again, there was no indication of metastasis or retroperitoneal nodal swelling. Histological examination of the resected stomach showed the lesion to be a signetring cell carcinoma, invading mainly the mucosal layer and only slightly the submucosal layer. Lymph-canal invasion was quite conspicuous and regional nodal involvement was evident. Data on routes of metastasis from analysis of seven cases, including the six formerly reported, of early gastric carcinoma with ovarian metastases are presented. No vascular invasion or liver metastasis was reported in any of the documented cases. No reports of peritoneal dissemination were found in the literature. The present findings support the theory of lymphatic spread in Kruckenberg metastasis.