【CLEAR Currier a daily case】Lower abdominal mass, how do you diagnose it?

【Case Introduction】

Patient Female, 52 years old
.

Physical examination: three masses of different sizes in the lower abdomen, hard, painless, transferable, emaciated, anemia
.

Assay: CAl99>1 000.

DR: Minor fluid accumulation in both pleural
spaces.

【Diagnosis】

(1) Ovarian metastases may be large in combination with clinical history;

(2) pelvic effusion;

(3) Low intestinal obstruction
.

Pathological confirmation: bilateral ovarian metastatic tumor (imprint cell carcinoma
).

【Discussion】

Krukenberg tumors, also known as imprint cell carcinoma
.

Proposed by Woodroff and Novack in 1960 and prescribed by the WHO in 1973, the histological diagnosis of Kukenberma: tumors grow in the ovaries; Microscopic visualization of ring-shaped mucus cells; Ovarian stroma with sarcoma-like infiltrates
.

CT findings: bilateral or unilateral ovarian mass with soft tissue density or a necrotic low-density area within it, significantly strengthened by enhanced scan masses, and no strengthening in the necrotic liquefaction area[1].

【Differential diagnosis】

(1) Serous and mucinous cystic adenocarcinoma, a large mass in the pelvic abdominal cavity, with multiple cystic parts of density of varying sizes and irregular morphologies, the spacing and thickness of the cyst wall are uneven, there may be obvious soft tissue density solid parts, and the tumor septum, capsule wall and solid part are significantly strengthened;

(2) Other primary malignant tumors of the ovary, often unilateral, no other primary tumors, and it is difficult to distinguish images;

(3) Benign ovarian tumors: more cystic, clear boundaries, can be strengthened, generally no ascites, long onset time, gradually enlarged, more asymptomatic;

(4) Pelvic inflammatory mass: the boundary of the mass can be clear, there is obvious strengthening, and there is no reinforcement in the central necrotic liquefaction area
.

(5) Interstitial origin tumor: often single-onset, soft tissue density, often strengthened, and the boundary is often clear
.

No other primary tumors
.

Main reasons:

First, the tumor has high malignancy, extremely poor prognosis, very few surgeries, short life, and less research;

Second, the clinical features are not familiar with the clinical features, and most of them are found to be advanced;

Third, ovarian metastases are thought to be less, especially Kukenburn.