AIM： To explore the expression and correlation of CD44v6, vascular endothelial growth factor （VEGF）, matrix metalloproteinase （MMP）-2 and matrix metalloproteinase （MMP）-9 in Krukenberg and primary epithelial ov...AIM： To explore the expression and correlation of CD44v6, vascular endothelial growth factor （VEGF）, matrix metalloproteinase （MMP）-2 and matrix metalloproteinase （MMP）-9 in Krukenberg and primary epithelial ovarian carcinoma. METHODS： The expressions of CD44v6, VEGF, MMP-2 and MMP-9 were detected by immunohistochemical method in 20 cases of normal ovarian tissues, 38 cases of Krukenberg tumor and 45 cases of primary epithelial ovarian carcinoma. RESULTS： The expression of CD44v6 （primary epithelial ovarian carcinoma tissue vs normal ovarian tissue： χ^2= 4.516, P= 0.034; Krukenberg tumor tissue vsnormal ovarian tissue： χ^2 = 19.537, P = 0.001） and VEGF （primary epithelial ovarian carcinoma tissue vs normal ovarian tissue： P = 0.026; Krukenberg tumor tissue vs normal ovarian tissue： χ^2 = 22.895, P = 0.001） was significantly higher in primary epithelial ovarian carcinoma tissue and Krukenberg tumor tissue than in normal ovarian tissue. The positive expression rate of MMP-2 and MMP-9 was 0% in the normal ovarian tissue. The positive expression rate of CD44v6 （ χ^2= 10.398, P= 0.001）, VEGF （ χ^2= 13.149, P = 0.001）, MMP-2 （ χ^2 = 33.668, P = 0.001） and MMP-9 （ χ^2= 38.839, P = 0.001） was remarkably higher in Krukenberg tumor than in primary epithelial ovarian carcinoma. The correlation of CD44v6, VEGF, MMP-2, and MMP-9 was observed in primary epithelial ovarian carcinoma and Krukenberg tumor. CONCLUSION： CD44v6, VEGF, MMP-2, and MMP-9 are involved in ovarian carcinoma, gastric cancer and Krukenberg tumor. Detection of CD44v6, VEGF, MMP-2 and MMP-9 may contribute to the diagnosis of ovarian carcinoma, gastric cancer, and Krukenberg tumor.展开更多
BACKGROUND Tumors of the spermatic cord are rare,and approximately 25%are malignant neoplasms.Metastatic spermatic cord tumors are even rarer.Several studies have revealed that the most frequent primary tumors metasta...BACKGROUND Tumors of the spermatic cord are rare,and approximately 25%are malignant neoplasms.Metastatic spermatic cord tumors are even rarer.Several studies have revealed that the most frequent primary tumors metastasizing to the spermatic cord and peritesticular tissues are neoplasms of the stomach and prostate.Furthermore,metastasis to the spermatic cord or epididymis may occur via retrograde lymphatic and hematic routes.We present the case of a man with gastric cancer that metastasized to the spermatic cord and epididymis,with concomitant ipsilateral hydronephrosis after surgical resection and chemotherapy for his primary tumor.CASE SUMMARY A 71-year-old man underwent total gastrectomy for pT4aN2 poorly differentiated gastric adenocarcinoma in December 2016.Two months after surgery,he received adjuvant chemotherapy with TS-1 from February 2017 to February 2018.Surveillance computed tomography(CT)was performed in June 2018,which did not reveal any sign of tumor recurrence.In November 2019,he presented with left lower quadrant abdominal pain and a palpable left inguinal-scrotal mass.CT revealed left mild hydronephrosis and a left scrotal mass measuring 4.0 cm×1.7 cm.Tumor biomarkers,including alpha-fetoprotein(AFP),lactate dehydrogenase(LDH),beta-human chorionic gonadotropin(βHCG),carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9(CA19-9)were all normal.Renal and testicular echography showed left hydronephrosis and a left peritesticular soft tissue lesion with blood flow.Diagnostic ureteroscopy showed left lower ureter narrowing without an intraluminal lesion.A biopsy was obtained for the indurated spermatic cord and epididymis,which showed poorly differentiated adenocarcinoma.Immunohistochemical staining demonstrated that the tumor was diffusely and strongly positive for homeobox protein CDX2.The features were consistent with metastatic adenocarcinoma of a primary gastric tumor.CONCLUSION In patients with a history of primary cancer,an inguinal mass of unknown cause with accompanying ipsilateral hydronephrosis may be a sign of distant metastasis from a primary tumor,especially of gastrointestinal origin.展开更多
Krukenbergtumor is a metastatic ovarian tumor with its primary site being the gastrointestinal tract. The pathogenesis of Krukenberg tumor formation is still in its hypothetical stage though the current understanding ...Krukenbergtumor is a metastatic ovarian tumor with its primary site being the gastrointestinal tract. The pathogenesis of Krukenberg tumor formation is still in its hypothetical stage though the current understanding suggests lymphatic, hematogenous and transcoelomic route as the 3 major route of metastasis. There is a lack of description in the literature related to the pathway of metastasis. Here, we intend to search the available literature and provide a thorough review, which may be helpful to the readers to understand the issue of mechanism of Krukenberg tumor metastasis more clearly.展开更多
We report a case of Krukenberg tumor of gastric origin with adnexal metastasis,in which ultrasonography(US) and contrast-enhanced US(CEUS) played a key diagnostic role.An 64-year-old female patient was referred to our...We report a case of Krukenberg tumor of gastric origin with adnexal metastasis,in which ultrasonography(US) and contrast-enhanced US(CEUS) played a key diagnostic role.An 64-year-old female patient was referred to our department for abdominal pain,nausea and ascites.US examination was performed as first line diagnostic imaging approach,confirming the presence of ascites and detecting marked thickness of the gastric wall and a right adnexal mass.CEUS was immediately performed and showed arterial enhancement followed by wash-out in the venous phase of both the gastric wall and the adnexal mass,suggesting the diagnosis of gastric cancer with right adnexal metastasis(Krukenberg syndrome).The patient underwent USguided paracentesis and esophagogastroduodenoscopy that showed linitis plastica.Cytologic examination of the peritoneal fluid revealed the presence of signetring cells,and histologic examination of the specimen obtained by endoscopic biopsy showed primary gastric mucus-producing adenocarcinoma with signetring cells.Although transvaginal US is undoubtedly the method of choice to evaluate ovarian tumors,abdominal US and CEUS can provide key diagnostic elements,supporting clinicians in the first steps of the diagnostic work-up of abdominal and pelvic masses.展开更多
AIM To determine the clinical characteristics of patients undergoing palliative surgery for Krukenberg tumors,including disease presentation,outcomes,and prognostic factors.METHODS This was a retrospective clinical st...AIM To determine the clinical characteristics of patients undergoing palliative surgery for Krukenberg tumors,including disease presentation,outcomes,and prognostic factors.METHODS This was a retrospective clinical study of all patients who underwent palliative surgery for Krukenberg tumors between January 2004 and December 2015.Patient information was obtained from inpatient and outpatient case notes as well as the hospital electronic records.Patients who underwent potential y curative resection,and patients with Krukenberg tumors who did not undergo surgery were also excluded from the study.Palliative surgery was defined as those performed for either alleviation of symptoms or for asymptomatic patients for whom surgical removal of the tumors were deemed necessary following a multidisciplinary consensus.Tumors were diagnosed pre-operatively by computed tomography scans and all had histologic confirmation of the surgical specimens.RESULTS Over the study duration,38 female patients underwent palliative surgery for Krukenberg tumors at our institution.Mean age was 54.2±11.7 years.The colon was the most frequent primary source of metastases(n=21)followed by the stomach(n=4).Prophylactic palliative surgery was performed for eight(21.1%)asymptomatic patients.Median post-operative length of stay was 8 d(IQR 6-12 d).Five patients(13.2%)experienced postoperative complications,although high grade morbidity was only seen in one patient(2.6%).Median overall survival from surgery was 17 mo(95%CI:12.1-21.9)at a median follow-up duration of 12 mo(IQR 8-17mo).The median survival was shorter for patients who underwent emergency surgery,younger patients,those with a colorectal primary,larger tumors,or synchronous peritoneal or hepatic metastases.CONCLUSION Pal iative surgery for Krukenberg tumors can be performed safely with acceptable complication rates.Bilateral oophorectomy should be performed to prevent the risk of symptomatic contralateral tumors.展开更多
Cancer cells with immunogenic properties having altered protein glycosylation, modified blood group substances have been widely studied. Due to the genetic instability occurring during carcinogenesis the glycosyltrans...Cancer cells with immunogenic properties having altered protein glycosylation, modified blood group substances have been widely studied. Due to the genetic instability occurring during carcinogenesis the glycosyltransferases may suffer from posttranslation sequence modification. The author describes 2 autopsy cases, where in the background of the unusual metastatic tumor presentation, incompatible blood group antigenic determinants have been demonstrated using blood group specific lectins and monoclonal antibodies (mAb). In the first case, reported here, a 10-year-old girl developed an acute myeloid leukemia and died in a septic endotoxin shock after successful cytostatic treatment of a juvenile signet ring cell cancer of her colon. At autopsy there were no signs of tumor except bilateral apple-sized mucinous ovarian (Krukenberg) metastases. While she had erythrocyte phenotype of blood group A, the signet ring adenocarcinoma cells expressed blood group B incompatible antigenic determinants with lectin/mAb. In the second case, the autopsy of a 78-year-old female resulted in no macroscopic tumor sign except a moderately enlarged, ham hard spleen. Light microscopy revealed adenocarcinomatous infiltration in the splenic sinusoids. The patient had blood group O, while the metastatic cells in the spleen reacted with Breast Carcinoma Antigen (BioGenex) and incompatible anti-B Banderiaeasimplicifolia agglutinin I and anti-B mAb. It proved to be a case of an occult, completely regressed breast cancer. Based on these observations the expression of tumor specific incompatible blood group antigens might occur from time to time, mostly in adenocarcinomas. Accordingly, blood group-based specific immuno-oncotherapy could be considered in some cancer cases.展开更多
Serum testosterone concentration levels were measured in 27 female patients with ovarian masses and n 8 female patients with malignant gastrointestinal tumors. The serum testasterone levels were found to be a more spe...Serum testosterone concentration levels were measured in 27 female patients with ovarian masses and n 8 female patients with malignant gastrointestinal tumors. The serum testasterone levels were found to be a more specific marker,compared with other methods, in the differential diagnosis of primary and metastatic tumors(P<0.01).Serum testosterone was at abnormally high levels inpatients with Krukenberg tumors assoiated with signet cells and luteinized stroma cells, but fell to very low levels after oophoiectomy. Testosterone levels were normal showever in patients with poorly-differentiated metastatic ovarisn tumors, or with gastro-intestinal cancers not involving the ovaries.We also found that testosaterone levels in patients with mucinous adenocarcinoma of either ovary or of the gastro-intestinal tract were higher than in patients with other types of tumor(P<0.05).展开更多
基金Supported by Foundation for Scholars Abroad of Ministry of Education of China, No. [2003]406Foundation of Heilongjiang Office of Education, No. 9551138
文摘AIM： To explore the expression and correlation of CD44v6, vascular endothelial growth factor （VEGF）, matrix metalloproteinase （MMP）-2 and matrix metalloproteinase （MMP）-9 in Krukenberg and primary epithelial ovarian carcinoma. METHODS： The expressions of CD44v6, VEGF, MMP-2 and MMP-9 were detected by immunohistochemical method in 20 cases of normal ovarian tissues, 38 cases of Krukenberg tumor and 45 cases of primary epithelial ovarian carcinoma. RESULTS： The expression of CD44v6 （primary epithelial ovarian carcinoma tissue vs normal ovarian tissue： χ^2= 4.516, P= 0.034; Krukenberg tumor tissue vsnormal ovarian tissue： χ^2 = 19.537, P = 0.001） and VEGF （primary epithelial ovarian carcinoma tissue vs normal ovarian tissue： P = 0.026; Krukenberg tumor tissue vs normal ovarian tissue： χ^2 = 22.895, P = 0.001） was significantly higher in primary epithelial ovarian carcinoma tissue and Krukenberg tumor tissue than in normal ovarian tissue. The positive expression rate of MMP-2 and MMP-9 was 0% in the normal ovarian tissue. The positive expression rate of CD44v6 （ χ^2= 10.398, P= 0.001）, VEGF （ χ^2= 13.149, P = 0.001）, MMP-2 （ χ^2 = 33.668, P = 0.001） and MMP-9 （ χ^2= 38.839, P = 0.001） was remarkably higher in Krukenberg tumor than in primary epithelial ovarian carcinoma. The correlation of CD44v6, VEGF, MMP-2, and MMP-9 was observed in primary epithelial ovarian carcinoma and Krukenberg tumor. CONCLUSION： CD44v6, VEGF, MMP-2, and MMP-9 are involved in ovarian carcinoma, gastric cancer and Krukenberg tumor. Detection of CD44v6, VEGF, MMP-2 and MMP-9 may contribute to the diagnosis of ovarian carcinoma, gastric cancer, and Krukenberg tumor.
文摘BACKGROUND Tumors of the spermatic cord are rare,and approximately 25%are malignant neoplasms.Metastatic spermatic cord tumors are even rarer.Several studies have revealed that the most frequent primary tumors metastasizing to the spermatic cord and peritesticular tissues are neoplasms of the stomach and prostate.Furthermore,metastasis to the spermatic cord or epididymis may occur via retrograde lymphatic and hematic routes.We present the case of a man with gastric cancer that metastasized to the spermatic cord and epididymis,with concomitant ipsilateral hydronephrosis after surgical resection and chemotherapy for his primary tumor.CASE SUMMARY A 71-year-old man underwent total gastrectomy for pT4aN2 poorly differentiated gastric adenocarcinoma in December 2016.Two months after surgery,he received adjuvant chemotherapy with TS-1 from February 2017 to February 2018.Surveillance computed tomography(CT)was performed in June 2018,which did not reveal any sign of tumor recurrence.In November 2019,he presented with left lower quadrant abdominal pain and a palpable left inguinal-scrotal mass.CT revealed left mild hydronephrosis and a left scrotal mass measuring 4.0 cm×1.7 cm.Tumor biomarkers,including alpha-fetoprotein(AFP),lactate dehydrogenase(LDH),beta-human chorionic gonadotropin(βHCG),carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9(CA19-9)were all normal.Renal and testicular echography showed left hydronephrosis and a left peritesticular soft tissue lesion with blood flow.Diagnostic ureteroscopy showed left lower ureter narrowing without an intraluminal lesion.A biopsy was obtained for the indurated spermatic cord and epididymis,which showed poorly differentiated adenocarcinoma.Immunohistochemical staining demonstrated that the tumor was diffusely and strongly positive for homeobox protein CDX2.The features were consistent with metastatic adenocarcinoma of a primary gastric tumor.CONCLUSION In patients with a history of primary cancer,an inguinal mass of unknown cause with accompanying ipsilateral hydronephrosis may be a sign of distant metastasis from a primary tumor,especially of gastrointestinal origin.
文摘Krukenbergtumor is a metastatic ovarian tumor with its primary site being the gastrointestinal tract. The pathogenesis of Krukenberg tumor formation is still in its hypothetical stage though the current understanding suggests lymphatic, hematogenous and transcoelomic route as the 3 major route of metastasis. There is a lack of description in the literature related to the pathway of metastasis. Here, we intend to search the available literature and provide a thorough review, which may be helpful to the readers to understand the issue of mechanism of Krukenberg tumor metastasis more clearly.
文摘We report a case of Krukenberg tumor of gastric origin with adnexal metastasis,in which ultrasonography(US) and contrast-enhanced US(CEUS) played a key diagnostic role.An 64-year-old female patient was referred to our department for abdominal pain,nausea and ascites.US examination was performed as first line diagnostic imaging approach,confirming the presence of ascites and detecting marked thickness of the gastric wall and a right adnexal mass.CEUS was immediately performed and showed arterial enhancement followed by wash-out in the venous phase of both the gastric wall and the adnexal mass,suggesting the diagnosis of gastric cancer with right adnexal metastasis(Krukenberg syndrome).The patient underwent USguided paracentesis and esophagogastroduodenoscopy that showed linitis plastica.Cytologic examination of the peritoneal fluid revealed the presence of signetring cells,and histologic examination of the specimen obtained by endoscopic biopsy showed primary gastric mucus-producing adenocarcinoma with signetring cells.Although transvaginal US is undoubtedly the method of choice to evaluate ovarian tumors,abdominal US and CEUS can provide key diagnostic elements,supporting clinicians in the first steps of the diagnostic work-up of abdominal and pelvic masses.
文摘AIM To determine the clinical characteristics of patients undergoing palliative surgery for Krukenberg tumors,including disease presentation,outcomes,and prognostic factors.METHODS This was a retrospective clinical study of all patients who underwent palliative surgery for Krukenberg tumors between January 2004 and December 2015.Patient information was obtained from inpatient and outpatient case notes as well as the hospital electronic records.Patients who underwent potential y curative resection,and patients with Krukenberg tumors who did not undergo surgery were also excluded from the study.Palliative surgery was defined as those performed for either alleviation of symptoms or for asymptomatic patients for whom surgical removal of the tumors were deemed necessary following a multidisciplinary consensus.Tumors were diagnosed pre-operatively by computed tomography scans and all had histologic confirmation of the surgical specimens.RESULTS Over the study duration,38 female patients underwent palliative surgery for Krukenberg tumors at our institution.Mean age was 54.2±11.7 years.The colon was the most frequent primary source of metastases(n=21)followed by the stomach(n=4).Prophylactic palliative surgery was performed for eight(21.1%)asymptomatic patients.Median post-operative length of stay was 8 d(IQR 6-12 d).Five patients(13.2%)experienced postoperative complications,although high grade morbidity was only seen in one patient(2.6%).Median overall survival from surgery was 17 mo(95%CI:12.1-21.9)at a median follow-up duration of 12 mo(IQR 8-17mo).The median survival was shorter for patients who underwent emergency surgery,younger patients,those with a colorectal primary,larger tumors,or synchronous peritoneal or hepatic metastases.CONCLUSION Pal iative surgery for Krukenberg tumors can be performed safely with acceptable complication rates.Bilateral oophorectomy should be performed to prevent the risk of symptomatic contralateral tumors.
文摘Cancer cells with immunogenic properties having altered protein glycosylation, modified blood group substances have been widely studied. Due to the genetic instability occurring during carcinogenesis the glycosyltransferases may suffer from posttranslation sequence modification. The author describes 2 autopsy cases, where in the background of the unusual metastatic tumor presentation, incompatible blood group antigenic determinants have been demonstrated using blood group specific lectins and monoclonal antibodies (mAb). In the first case, reported here, a 10-year-old girl developed an acute myeloid leukemia and died in a septic endotoxin shock after successful cytostatic treatment of a juvenile signet ring cell cancer of her colon. At autopsy there were no signs of tumor except bilateral apple-sized mucinous ovarian (Krukenberg) metastases. While she had erythrocyte phenotype of blood group A, the signet ring adenocarcinoma cells expressed blood group B incompatible antigenic determinants with lectin/mAb. In the second case, the autopsy of a 78-year-old female resulted in no macroscopic tumor sign except a moderately enlarged, ham hard spleen. Light microscopy revealed adenocarcinomatous infiltration in the splenic sinusoids. The patient had blood group O, while the metastatic cells in the spleen reacted with Breast Carcinoma Antigen (BioGenex) and incompatible anti-B Banderiaeasimplicifolia agglutinin I and anti-B mAb. It proved to be a case of an occult, completely regressed breast cancer. Based on these observations the expression of tumor specific incompatible blood group antigens might occur from time to time, mostly in adenocarcinomas. Accordingly, blood group-based specific immuno-oncotherapy could be considered in some cancer cases.
文摘Serum testosterone concentration levels were measured in 27 female patients with ovarian masses and n 8 female patients with malignant gastrointestinal tumors. The serum testasterone levels were found to be a more specific marker,compared with other methods, in the differential diagnosis of primary and metastatic tumors(P<0.01).Serum testosterone was at abnormally high levels inpatients with Krukenberg tumors assoiated with signet cells and luteinized stroma cells, but fell to very low levels after oophoiectomy. Testosterone levels were normal showever in patients with poorly-differentiated metastatic ovarisn tumors, or with gastro-intestinal cancers not involving the ovaries.We also found that testosaterone levels in patients with mucinous adenocarcinoma of either ovary or of the gastro-intestinal tract were higher than in patients with other types of tumor(P<0.05).
