Gastric cancer is one of the most commonly diagnosed malignancies in South Korea. Female patients with advanced gastric cancer, in particular premenopausal patients, are also often found to have Krukenberg tumors. Because of this, when a large pelvic or ovarian mass is detected in gastrointestinal malignancy patients, physicians try to exclude the presence of a Krukenberg tumor. The incidence of uterine fibroid tumors increases as women grow older and these tumors may occur from 4 percent in women 20 to 30 years of age to 11 to 18 percent in women 30 to 40 years of age and 33 percent in women 40 to 60 years [
A 44-year-old woman was admitted to our hospital with general weakness, dyspepsia, abdominal distension, and a palpable mass that had been present for two weeks. The patient appeared pale and was chronically ill. She stated that she had lost 6 kg over the last two months. On physical examination, she was oriented to time, place, and person. Her vital signs were as follows: blood pressure of 130/75 mmHg, pulse rate of 83 beats/min, and respiration rate of 24 breaths/min. Abdominal examination revealed a mass that was palpable over the entire abdomen. There was no jaundice, cyanosis, or diaphoresis. Neurological and cardiac examinations did not exhibit any pathological findings. Tumor marker levels including carcinoembryonic antigen (CEA), human chorion gonadotropin (HCG), CA19-9, and CA15-3 were all within normal range, but CA125 was high at 171 U/mL. An abdominal computed tomography scan (Figure
Abdominal computed tomography (CT) showing a huge solid mass occupying whole pelvis and abdomen.
F-18 fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) images.
Macroscopic view of uterine fibroid tumor.
Female patients with advanced gastric cancer, particularly in the premenopausal state, are subject to Krukenberg tumors [
The use of estrogen agonists is associated with an increased incidence of fibroid tumors [
Pelvic pain and pressure are less commonly attributed to uterine fibroid tumors. Individual case reports have described very large tumors that result in pelvic discomfort, respiratory failure, urinary symptoms, and constipation [
The role of uterine fibroid tumors in infertility is controversial. Many studies examining the relationship between these tumors and infertility are retrospective and nonrandomized. Current evidence suggests that submucosal and intramural fibroid tumors that distort the uterine cavity can impair in vitro fertilization attempts [
Uterine myomas are classified into subgroups according to their position and relationship to the uterine layers. These tumors become symptomatic based on their position within the uterus and their size. Tumors are usually distinguished by the following characteristics: (a) intramural myomas; (b) submucosal (endocavitary) myomas, which can be pedunculated or sessile and can extend into the myometrium; (c) subserosal myomas, which can be pedunculated or sessile and are located just beneath the covering peritoneum of the uterine corpus; (d) isthmus or cervical myomas; and (e) extrauterine (intraligamentary or intraovarian) myomas [
The treatment for uterine fibroid tumors with no symptoms and a small size is observation at intervals of 6 months. In terms of medical therapy, GnRH agonists, medroxyprogesterone acetate, danazol, and mifepristone (RU 486), which reduces the serum progesterone and estrogen, were reported to reduce the fibroid volume. Surgical treatment can be considered in cases of abnormal bleeding with sustained endometrial hyperplasia or when no improvement is seen with palliative therapy, and uterine artery embolization has been used recently in these cases. A total hysterectomy or myomectomy should be considered based on the patient’s age, parity, and future pregnancy plans. Decreases in serum estrogen levels are expected after menopause, which may cause a decrease in the size of the myoma, so surgical removal is therefore not required in most patients who are approaching menopause [
In this case, a surgical resection was required to resolve an intestinal obstruction and to exclude the possibility of a Krukenberg tumor. We report a surgical resected uterine fibroid tumor in a patient with advanced gastric cancer.
Written informed consent was obtained from the patient for publication of this case report and accompanying images.
The authors have no conflict of interests to declare.
The patient was under the care of Kwang-Kuk Park; Song-I Yang operated on the patient. Kwang-Kuk Park and Song-I Yang analyzed and interpreted the data. Kwang-Kuk Park wrote the paper. Song-I Yang added to the paper. Song-I Yang edited the final version of the paper. All authors reviewed and approved the final paper.