A Case of Metachronous Metastases to the Ovaries and Spleen from Advanced Gastric Carcinoma

Hiroshi Itoh, Etsuro Bando, Taiichi Kawamura, Toru Ii, Shigeru Takegawa, Masato Kiriyama, Shoutaro Dohba and Yasuhiko Kojima

Department of Surgery, National Kanazawa Hospital

A 50-year-old woman complaining of a left upper quadrant pain was admitted to hospital. The patient's past medical history included a subtotal gastrectomy with a D2 lymphadenectomy for advanced carcinoma of the stomach 39 months previously and a bilateral oophorectomy for Krukenberg tumor16months before admission. The histopathological findings revealed a moderately differentiated adenocarcinoma (type 3 macroscopic findings, SE, INFγ, ly1, v0, N0). On admission, biochemical investigations showed an elevation of carbohydrate antigen 72-4. An abdominal ultrasonography and a computed tomography revealed a solitary splenic tumor approximately 5 cm in diameter. A barium enema examination demonstrated an ulcerative lesion of the descending colon and a narrowing of the entire circumference of the transverse colon. Under a diagnosis of metastatic splenic tumor of gastric carcinoma, a splenectomy with resection of the colon and diaphragm was performed. The cut surface of the resected specimen showed a yellow-white elastic hard tumor in the spleen that had invaded the colon and diaphragm. The histological findings of the splenic tumor were compatible with those of a metastatic carcinoma with invasion into the colon and diaphragm, originating from the gastric carcinoma. The patient is alive and has been free of recurrence for thirteen months after the operation.

Key words
gastric carcinoma, splenic tumor, metachronous metastasis

Reprint requests
Hiroshi Itoh Department of Surgery, National Kanazawa Hospital
1-1 Shimoishibiki, Kanazawa, 920-8650 JAPAN

Accepted
September 19, 2001

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