Gastric Adenocarcinoma Case Study

A 56-year-old woman with a history of gastric adenocarcinoma comes to the emergency department with a history of abdominal and pelvic pain, along with bloating for the past 3 weeks. Five months ago she received a cycle of epirubicin, cisplatin, and 5-fluorouracil. This was her fourth cycle of chemotherapy, and her oncologist advised her that her follow-up CT scan showed no reduction in the size of her tumor after treatment. She feels tired and bloated currently. Her temperature is 37.5°C (99.5ºF), blood pressure is 100/60 mmHg, and pulse is 115 beats/min. The lungs have crackles at the bases bilaterally to auscultation. Cardiac exam reveals tachycardia, but no other abnormalities. The abdomen is distended and minimally tender throughout all four quadrants. A fluid wave is appreciated on exam.
CT scan with contrast of the pelvis shows the following lesion (identified by arrows): [1A]
What is the most likely diagnosis in this patient?
A. Brenner tumor
B. Carcinoid tumor
C. Endometrial adenocarcinoma
D. Krukenberg tumor
E. Polycystic ovarian syndrome

Choice “D” is the best answer. A Krukenberg tumor is a tumor of
Salt and salted foods may damage the gastric mucosa, leading to inflammation and an associated increase in DNA synthesis and cell proliferation. Other factors increasing the risk of gastric cancer include chronic Helicobacter pylori infection, previous gastric surgery, pernicious anemia, chronic atrophic gastritis, radiation exposure, and polpyposis syndromes. The vascular and lymphatic supply of the stomach allows for hematogenous spread of cancers affecting other parts of the body. There has been debate over the exact mechanism of metastasis of the tumor cells from the stomach, appendix or colon to the ovaries. Classically it was thought that direct seeding across the abdominal cavity accounted for the spread of this tumor, but spread by way of the lymphatic is now considered more