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

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  • 胃癌根治術後異時性に卵巣および脾転移をきたした1手術例

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Abstract

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 tumor 16 months 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.

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