A 47 year old women underwent Total Abdominal Hysterectomy and Bilateral salpingo oophorectomy in 2011. Histopatholgy shows it was Krukenberg tumour. She had oral chemotherapy for carcinoma in the stomach. Now she has presented with loss of appetite, slight loss of weight and a mass in the Right iliac fossa. Blood work up -esr is 40, CA125 is 50, LFT are normal. OGD showed mid body gastric poorly differentiated adenocarcinoma. PET CT -Increased uptake of pet at the appendix which is distended with inflammatory signs,compared to previous ct there is slight regression in size.The rest was normal. She refuses to have chemotherapy again.
She has done very well so far. The prognosis of Krukenburg tumours from gastric cancer is dismall. I'm very surprized she has survived 3 years. Why wasn't she workedup with the OGD etc in 2011? Do you think the appendix lesion is a peritoneal metastasis or is it another primary? Is she getting any symptoms from the gastric primary? Would you need do a total or subtotal gastrectomy?
Given she is young and presumably fit one option is to perform a staging laparoscopy - if no other peritoneal or omental disease - remove the appendix lesion and follow on with a gastrectomy. However, I would say is likely to be other disease and the whole exercise will be palliative in nature.
In the UK we do peritoneal cytology to stage gastric cancer; as if cytology is positive prognosis is so poor their is no benefit from surgical resection.
Thanks Ewen,she is fit and she was operated and treated 2000 km from our centre and I donot have any other details.My plan is exactly on the same lines as you mentioned.Palliative nature of treatment was explained.Staging Laparoscopy first and then proceed.
This is to keep you updated that staging Laparoscopy was done.Nevidence of peritoneal disease consistent with pet ct.Mass in the RIF with inlammed tip of appendix as small bowel loops are densly adherent.Abdomen was opened and on dissction it was found appendicular perf with pus.Appendicectomy was done followed by distal subtotal D1 Gastrectomy.No macoroscopic glands and the tumour was freely moble.
Thanks for the follow-up. Thats good news! If you can I would try to get the pathologist to examine the previous oopherectomy specimen and the new gastric specimen. All the best. Ewen
Thanks,i got previous histopathology report and it is krukenburg tumour.Previously upper Gi endoscopyx2 confirmed the Gastric carcinoma and then oral chemo was administered.Is n't it a rare problem?
- Badges
- Science topic
- Similar topics
- Correction