CASE 4045 Published on 16.09.2005

CARCINOMA OF THE STOMACH – LINITIS PLASTICA WITH METASTASES ON THE OVARIA- KRUKENBERG TUMOUR CASE REPORT

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Antonio Gligorievski, Svetlana Temelkovska, Jadranka Stojanovska

Patient

45 years, female

Clinical History
On the base of the clinical and radiological results the final diagnosis was made: inoperative carcinoma of the stomach of scirrhous type – linitis plastica, with MS changes in the peritoneum and ovaria – Krukenberg tumor.
Imaging Findings
A patient was received at the Clinic for abdominal surgery due to stomach pain, nausea, vomitus, and weight loos approximately 20 kg in the last 6-8 weeks. The sedimentation was elevated 160 in the first hour, and there is an extreme elevation of CA19-9, U/ml>400,0 (0,0-20,24) and CA125, U/ml>540,0 (0,0-35,0), a moderate elevation of CA72-4, U/ml 20,8 (0.0-9,6) and the CEA, ng/ml 1,9 (0,0-3,4) is within normal values. Radiological picture of the stomach is with circular infiltration of the wall in region of corpus and antrum, with reduced volume and strongly expressed diffuse rigidity. On the US examination there is an infiltration on the stomach wall and TU formation on the right and left ovary with cystic elements and necrotic zones in the same. There is ascit in the abdominal cavity in an amount of more than 1500 ml. CT of the abdomen were made after per os given 700 ml of water, in hypotonia achieved through i.v. application of glucagon. The stomach was with rigid and thickened more than 20-30 mm wall, with diffuse infiltration, without signs of penetration of the serosa and spreading towards neighbour organs, the volume is much reduced. Collection of ascitic fluid is seen in the abdominal cavity, which is in favour of MS changes of the peritoneum. The intestinal loops are stagnant, and pushed in lateral direction by the soft tissue TU formations, predominantly solid but with apparent zones of destruction that belong to the ovaria. The larger TU mass belongs to the right ovary.
Discussion
Carcinoma of the stomach is a frequent and severe disease that most often is detected in the late phase, when there is a large tumor mass that occupies almost all layers of the stomach wall, with low survival rate that depends on the differentiation and stage of the disease. Most of the it occurs in the period between 40 and 60 years of age, and the sex distribution varies from 2:1 to 2:1,5 between men and women depending on the region and race, but still it is never equal. Before occupying the neighbour organs, pathological deposits in the lymph glands, liver and distant organs occur. Macroscopically and radiologically the carcinoma of the stomach is: Protrusive (polyposis, encephaloid) that sticks out into the cavity of the organ; Infiltrative (scirrhous, stenotic) which most often occupies the deeper layers of the stomach wall and ulcerative. Approximately 10% of the carcinoma of the stomach show local or diffuse spreading through the wall (linitis plastica) and 5% are with surface spreading into the normal mucosa of the stomach. Digestive linitis plastica is a special form of poorly differentiated adenocarcinoma that can occupy all segments of the digestive tube, the most frequent localization is the stomach, and the rarest is the double occurrence on the stomach and on the rectum. (2). More frequent is the diffuse spreading through the wall where the entire thickness of the wall is infiltrated that is linitis plastica occurs. The wall is notably thickened up till 2-3 cm and becomes solid as cartilage. Regardless to the macroscopic appearance, the histological picture usually shows well-differentiated adenocarcinoma, but also different degrees of differentiation can be found up to completely non-differentiated growth. (1,2,3) Radiologically the infiltrative type of carcinoma of the stomach is always with expressed desmoplastic reaction of the stomach wall so the only symptom can be the rigidity of the wall. In severe occupancy of the wall the final result is stenosis of the lumen and disappearance of the mucosa relief. The ovarial tumors are divided into three groups: epithelial tumor (serous and mucinous cistoma, endometrial tumors and non differentiated carcinomas); connective tissue tumors (fibromas, teka cells tumors and sarcomas); embryonal tumors – teratomas (dermoid cysts and teratoblastomas). Metastatic ovarial carcinoma that are 25-30 % of all ovarial carcinoma occur with scattering of canceromatose cells from carcinoma of other organs, most often tumor of the stomach, breast and uterus. In 75 % of the metastatic carcinomas on the ovary the primary tumor is on the stomach that is on the digestive tube (40. 11 % on the breast and 7 % on the body of uterus. Metastatic ovarial carcinomas grow fast and achieve size of a fist up till the size of a child’s head, and opposite of this the primary tumor can be very small and may not give any signs of its existence and can be found only on obduction. Usually metastatic tumor on the ovary which primary site is on the stomach are called Krukenberg tumor.
Differential Diagnosis List
Linitis plastica, with MS in ovaria – Krukenberg tumor,
Final Diagnosis
Linitis plastica, with MS in ovaria – Krukenberg tumor,
Case information
URL: https://eurorad.org/case/4045
DOI: 10.1594/EURORAD/CASE.4045
ISSN: 1563-4086