Gynecological disease turned out to be stomach disease

Outpatient observation: Ms. Li visited Dr. Wang’s gynecological clinic because of “lower abdominal pain for one month”. After Dr. Wang received the patient, he performed a gynecological examination and found that a 5cm mass could be felt in Ms. Li’s pelvic adnexal area with poor mobility. A pelvic B-ultrasound was performed immediately, which indicated: “A substantial mass in the pelvic cavity with rich blood flow signals. The ovarian source may be considered.” However, the attentive Dr. Wang inquired about Ms. Li’s past medical history and whether she had any gastrointestinal diseases in the past. Ms. Li said that she had stomach problems but did not receive regular treatment. Dr. Wang asked her to check the tumor indicators in her blood and told her to go to the gastroenterology department for a gastroscopy. Ms. Li didn’t understand. She clearly had no stomach discomfort, only lower abdominal pain. Why did she have to undergo this unnecessary examination? Based on Ms. Li’s doubts, Dr. Wang patiently explained:

When symptoms such as "lower abdominal pain and ovarian mass" appear, ovarian tumors should be considered first.

Ovarian tumors can be divided into benign tumors and malignant tumors.

At the same time, the ovary is also a common site for malignant tumor metastasis, also known as metastatic ovarian tumor. Metastatic ovarian tumors usually have a poor prognosis and are often misdiagnosed due to the lack of clinical manifestations of the primary lesion, delaying treatment. Therefore, the diagnosis of primary ovarian tumors also requires the exclusion of the possibility of metastatic ovarian tumors.

Krukenberg tumor is broadly defined as a type of ovarian metastatic tumor dominated by signet ring cells. The incidence of this disease accounts for more than 10% of ovarian malignant tumors. The origin of Krukenberg tumors includes the digestive tract, pancreas, gallbladder, breast, kidney, lung, etc., among which the stomach is the most common primary site. Tumor cells from the primary site, through lymphatic metastasis, hematogenous metastasis or abdominal cavity directly implanted to the ovary to form ovarian tumors.

Differences between Krukenberg tumor and primary ovarian malignant tumor

1. Age of onset

Krukenberg tumors occur at an earlier age than primary ovarian cancers, which usually occur in postmenopausal women, while Krukenberg tumors occur more often in premenopausal women.

2. In imaging

Primary ovarian malignant tumors are mostly unilateral masses, mostly solid in nature, while Krukenberg tumors are mostly bilateral ovarian masses, mostly cystic and solid in nature. Therefore, we need to be more vigilant about ovarian masses that appear as cystic masses to prevent missed diagnosis of the primary lesion.

3. Tumor Markers

The increase in tumor markers CA125 and CEA in Krugman's tumor is not as obvious as that in primary ovarian malignant tumor, and the immunohistochemical staining of the two is not exactly the same. Of course, the above can only be used as a reference for distinguishing the two, and the actual diagnosis depends on the comprehensive judgment of medical professionals.

Therefore, for symptoms such as lower abdominal pain and ovarian masses, we need to be alert to the possibility of metastatic ovarian tumors secondary to gastric cancer, and we cannot ignore the treatment of the primary lesion. After listening to Dr. Wang's explanation, Ms. Li went for a gastroscopy, and a week later, the pathology showed "gastric cancer"......

Kind tips:

The cause of ovarian tumors is currently unknown and difficult to prevent, but we can strengthen education, early detection, early treatment, and improve the cure rate.

1. Improve the scientific knowledge of the masses on disease prevention

2. Carry out census and general treatment

3. Early detection of tumors and timely treatment: Ovarian tumors larger than 4 cm, especially solid masses and prepubertal and postmenopausal women should be vigilant.

4. Close follow-up and gynecological examination for patients with breast cancer and gastrointestinal tumors after treatment.

References: Obstetrics and Gynecology, 9th Edition, Internal Medicine, 9th Edition

Note: There is no copyright issue for the pictures in this article

Author: Wang Ying, Liu Zhou, Zhao Jiangxia, Zhoupu Hospital, Shanghai Health and Medical College

Funded by Shanghai Science and Technology Commission's Science Popularization Project

(Project No.: 20DZ2311100)