Chen Han-Ying, Lee Chien-Nan, Lin Shin-Yu
Department of Obstetrics and Gynecology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Ann Med Surg (Lond). 2023 Apr 11;85(5):2056-2058. doi: 10.1097/MS9.0000000000000499. eCollection 2023 May.
The incidence of ovarian tumors in pregnancy is around 0.05%. Primary ovarian cancer and metastatic malignancy are rare in pregnancy, and women often delayed in diagnosis.
This is the first case ever reported on gastric cancer diagnosed during pregnancy presenting with a Krukenberg tumor and mimic ovarian tumor torsion, cholecystitis. By reporting this case, we could sensitize physicians to be more vigilance of abnormal abdominal pain in pregnant women.
A 30-year-old female came to our hospital at the 30th week of gestational age due to preterm uterine contraction and worsening abdominal pain. A cesarean section was performed due to preterm uterine contraction and intolerable abdominal pain suspected to be ovarian torsion. Microscopic examination of the ovarian specimen showed signet-ring cells. The patient was diagnosed with gastric adenocarcinoma at stage IV after complete surveillance. Postpartum chemotherapy consisted of oxaliplatin and high-dose 5-fluorouracil. The patient died 4 months after delivery.
Malignancies during pregnancy should be kept in mind while encountering atypical clinical presentations. Krukenburg tumor is rare in pregnancy and gastric cancer is the most common cause. Early diagnosis of the gastric cancer in the operable stage is the key to a better prognosis.
Diagnostic examinations for gastric cancer in pregnancy could be performed after first trimester. Treatment should be introduced after balancing maternal-fetal risks. Early diagnosis and intervention are crucial to decrease the high mortality rate of gastric cancer in pregnancy.
妊娠期卵巢肿瘤的发生率约为0.05%。原发性卵巢癌和转移性恶性肿瘤在妊娠期较为罕见，女性往往诊断延迟。
这是首例报道的妊娠期诊断为胃癌并伴有库肯勃瘤，且酷似卵巢肿瘤扭转、胆囊炎的病例。通过报道该病例，我们可以提高医生对孕妇异常腹痛的警惕性。
一名30岁女性在孕30周时因先兆早产和腹痛加重前来我院。因怀疑卵巢扭转导致先兆早产和难以忍受的腹痛而进行了剖宫产。卵巢标本的显微镜检查显示印戒细胞。经过全面检查后，患者被诊断为IV期胃腺癌。产后化疗采用奥沙利铂和高剂量5-氟尿嘧啶。患者在分娩后4个月死亡。
遇到非典型临床表现时应考虑妊娠期恶性肿瘤。库肯勃瘤在妊娠期罕见，胃癌是最常见的原因。可手术阶段的胃癌早期诊断是改善预后的关键。
妊娠期胃癌的诊断检查可在孕早期后进行。在平衡母婴风险后应开始治疗。早期诊断和干预对于降低妊娠期胃癌的高死亡率至关重要。
