Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2016; 22(16): 4270-4274
Published online Apr 28, 2016. doi: 10.3748/wjg.v22.i16.4270
Occult gastric cancer with distant metastasis proven by random gastric biopsy
Sang Hyuk Lee, Kyu-Hyoung Lim, Seo-Young Song, Hui-Young Lee, Sung Chul Park, Chang Don Kang, Sung Joon Lee, Dong Wook Choi, Sung Bae Park, Young-Joon Ryu
Sang Hyuk Lee, Kyu-Hyoung Lim, Seo-Young Song, Hui-Young Lee, Sung Chul Park, Chang Don Kang, Sung Joon Lee, Dong Wook Choi, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24341, South Korea
Sung Bae Park, Department of General Surgery, Kangwon National University School of Medicine, Chuncheon 24341, South Korea
Young-Joon Ryu, Department of Pathology, Kangwon National University School of Medicine, Chuncheon 24341, South Korea
Author contributions: Lee SH and Lim KH designed the case report, analyzed the data and wrote the paper; Song SY, Lee HY, Park SC, Kang CD, Lee SJ and Park SB collected the patient’s clinical data; Ryu YJ performed the pathologic review.
Supported by 2013 Research Grant from Kangwon National University, No. C1010351-01-01.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards of Kangwon National University Hospital (Approval No. 2015-11-015).
Informed consent statement: Because the patient involved in this study passed away, we were allowed an exemption of informed consent from the Institutional Review Board standards of Kangwon National University Hospital (Approval No. 2015-11-015).
Conflict-of-interest statement: All the authors declare they have no conflicts of interests related to the publication of this case report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kyu-Hyoung Lim, MD, Assistant Professor, Division of Hemato-Oncology, Department of Internal Medicine, Kangwon National University School of Medicine, 156 Baengnyeong-ro, Chuncheon-Si, Gangwon-Do 24341, South Korea. kyuhyoung.lim@gmail.com
Telephone: +82-33-2589173 Fax: +82-33-2582404
Received: October 25, 2015
Peer-review started: October 26, 2015
First decision: November 13, 2015
Revised: December 10, 2015
Accepted: January 17, 2016
Article in press: January 18, 2016
Published online: April 28, 2016
Processing time: 176 Days and 16.7 Hours
Abstract

Krukenberg tumor, a rare metastatic ovarian tumor arising from gastrointestinal adenocarcinoma mainly, tends to occur in premenopausal females. Finding the origin of a Krukenberg tumor is crucial for determining prognosis. In Eastern countries, the most common origin of Krukenberg tumor is stomach cancer, which is generally diagnosed via endoscopic biopsy to investigate an abnormal mucosal lesion. Here, we describe a case of huge adnexal mass in a 33-year-old woman who presented with abdominal distension. Two independent endoscopic examinations performed by experts in two tertiary university hospitals revealed no abnormal mucosal lesion. The patient was diagnosed with a Krukenberg tumor according to findings from random endoscopic biopsies taken from normal-looking gastric mucosa in our hospital. It is very rare to be diagnosed via a random biopsy in cases where three well-trained endoscopists had not found any mucosal lesion previously. Thus, in this case, random biopsy was helpful in finding the origin of a Krukenberg tumor.

Keywords: Gastric cancer; Krukenberg tumor; Biopsy; Endoscopy; Diagnosis

Core tip: We describe a 33-year-old woman who was diagnosed with Krukenberg tumor of gastric origin after random biopsy taken during endoscopy for normal-looking mucosa. Although three well-trained endoscopists confirmed that there was no mucosal lesion in the stomach, the random biopsy from the corpus showed signet ring cell carcinoma. Clinical significance of this case is that clinicians should consider gastric malignancy for patients who have Krukenberg tumor of which the origin has not been found, even when the gastric mucosa appears to be intact. For these patients, random gastric biopsy may help to reveal the primary cancer.