Diffuse gastric cancer with Krukenberg tumor: A case report and literature review

Diffuse gastric carcinoma (DGC) is histologically characterized by increased intracellular mucin production, leading to a “signet ring cell differentiation” in tumor cells. Signet-ring tumor cells are often rapidly progressive in nature, with tumor cells diffusely infiltrating the stomach, leading to desmoplasia and thickening of the gastric wall (linitis plastica). Like intestinal gastric carcinoma (IGC), DGC can be associated with H. pylori infections, among other environmental factors such as smoking, alcohol, and socioeconomic status. DGC, however, is characterized by a higher mortality and poorer prognosis than IGC due to its rapid progression, higher metastatic potential, and delayed diagnosis. Common presentation in those with DGC include weight loss, generalized abdominal pain, nausea and vomiting. In our specific case, the rare presentation of DGC with metastasis to the peritoneum, small intestine, colon, left ovary and fallopian tube can be appreciated. A 54-year-old female presented with consistent, generalized abdominal pain, leading to an exploratory laparotomy for suspected adhesions. Examination revealed numerous tumors throughout the abdomen and pelvis, with omental and mesenteric implants. Multiple biopsies of the ovaries, mesenteric implants, and omental implants revealed welldefined glands lined by moderately atypical nuclei and focal luminal necrosis. Diagnosis of DGC with metastatic spread and Krukenberg tumors (KT) was made and treatment was initiated with palliative chemotherapy. DGC with KT is remarkably rare, as only 1% of metastatic ovarian tumors result from gastric primaries. The grim prognosis is due to rapid disease progression, advanced stage at presentation, and late diagnosis. As such, effective treatment for this subset of patients cannot be initiated. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 11, November 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(11):733–737. www.ijcasereportsandimages.com Khosla et al. 733 CASE REPORT OPEN ACCESS Diffuse gastric cancer with Krukenberg tumor: A case report and literature review Manraj Khosla, Ali Imran, Panagiotis Fidias