Introduction. Uterine fibroid tumors (uterine leiomyomas) are the most common benign uterine tumors. The incidence of uterine fibroid tumors increases in older women and may occur in more than 30% of women aged 40 to 60. Many uterine fibroid tumors are asymptomatic and are diagnosed incidentally. Case Presentation. A 44-year-old woman was admitted to our hospital with general weakness, dyspepsia, abdominal distension, and a palpable abdominal mass. An abdominal computed tomography scan showed a huge tumor mass in the abdomen which was compressing the intestine and urinary bladder. Gastroduodenal endoscopic and biopsy results showed a Borrmann type IV gastric adenocarcinoma. The patient was diagnosed with gastric cancer with disseminated peritoneal carcinomatosis. She underwent a hysterectomy with both salphingo-oophorectomy and bypass gastrojejunostomy. Simultaneous uterine fibroid tumor with other malignancies is generally observed without resection. But in this case, a surgical resection was required to resolve an intestinal obstruction and to exclude the possibility of a metastatic tumor. Conclusion. When a large pelvic or ovarian mass is detected in gastrointestinal malignancy patients, physicians try to exclude the presence of a Krukenberg tumor. If the tumors cause certain symptoms, surgical resection is recommended to resolve symptoms and to exclude a metastatic tumor. 1. Introduction 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 [1]. Many tumors are asymptomatic and are diagnosed incidentally. Although a causal relationship has not been established, uterine fibroid tumors are associated with menorrhagia, pelvic pain, pelvic or urinary obstructive symptoms, infertility, and pregnancy loss. A patient recently visited our hospital with sudden onset abdominal distension and indigestion. The patient was diagnosed with stomach cancer and suspected metastatic uterine tumors. We performed a hysterectomy with both a salphingo-oophorectomy and a bypass gastrojejunostomy. A very large uterine mass
References
[1]
S. Lurie, I. Piper, I. Woliovitch, and M. Glezerman, “Age-related prevalence of sonographicaly confirmed uterine myomas,” Journal of Obstetrics & Gynaecology, vol. 25, no. 1, pp. 42–44, 2005.
[2]
N. K. Kim, H. K. Kim, B. J. Park et al., “Risk factors for ovarian metastasis following curative resection of gastric adenocarcinoma,” Cancer, vol. 85, no. 7, pp. 1490–1499, 1999.
[3]
E. Chalas, J. P. Costantino, D. L. Wickerham et al., “Benign gynecologic conditions among participants in the Breast Cancer Prevention Trial,” American Journal of Obstetrics & Gynecology, vol. 192, no. 4, pp. 1230–1239, 2005.
[4]
K. A. Kovács, A. Oszter, P. M. G？cze, J. L. K？rnyei, and I. Szabó, “Comparative analysis of cyclin D1 and oestrogen receptor (α and β) levels in human leiomyoma and adjacent myometrium,” Molecular Human Reproduction, vol. 7, no. 11, pp. 1085–1091, 2001.
[5]
M. Shozu, H. Sumitani, T. Segawa et al., “Overexpression of aromatase P450 in leiomyoma tissue is driven primarily through promoter I.4 of the aromatase P450 gene (CYP19),” The Journal of Clinical Endocrinology & Metabolism, vol. 87, no. 6, pp. 2540–2548, 2002.
[6]
T. Maruo, N. Ohara, J. Wang, and H. Matsuo, “Sex steroidal regulation of uterine leiomyoma growth and apoptosis,” Human Reproduction Update, vol. 10, no. 3, pp. 207–220, 2004.
[7]
A. Barbarisi, O. Petillo, A. Di Lieto et al., “17-beta estradiol elicits an autocrine leiomyoma cell proliferation: evidence for a stimulation of protein kinase-dependent pathway,” Journal Cellular Physiology, vol. 186, no. 3, pp. 414–424, 2001.
[8]
L. A. Wise, J. R. Palmer, E. A. Stewart, and L. Rosenberg, “Age-specific incidence rates for self-reported uterine leiomyomata in the Black Women's Health Study,” Obstetrics & Gynecology, vol. 105, no. 3, pp. 563–568, 2005.
[9]
G. Oelsner, S. E. Elizur, Y. Frenkel, and H. Carp, “Giant uterine tumors: two cases with different clinical presentations,” Obstetrics & Gynecology, vol. 101, no. 5, part 2, pp. 1088–1091, 2003.
[10]
D. Courban, S. Blank, M. A. Harris, J. Bracy, and P. August, “Acute renal failure in the first trimester resulting from uterine leiomyomas,” American Journal of Obstetrics & Gynecology, vol. 177, no. 2, pp. 472–473, 1997.
[11]
R. P. C. Chaparala, A. S. Fawole, N. S. Ambrose, and A. H. Chapman, “Large bowel obstruction due to a benign uterine leiomyoma,” Gut, vol. 53, no. 3, pp. 386–430, 2004.
[12]
A. H. Brand, J. P. Scurry, R. S. Planner, and P. T. Grant, “Grapelike leiomyoma of the uterus,” American Journal of Obstetrics & Gynecology, vol. 173, pp. 959–961, 1995.
[13]
J. S. Berek and E. Novak, Berek and Novak's Gynecology, Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 2007.
[14]
B. W. Rackow and A. Arici, “Fibroids and in-vitro fertilization: which comes first?” Current Opinion in Obstetrics & Gynecology, vol. 17, no. 3, pp. 225–231, 2005.
[15]
B. McLucas, “Diagnosis, imaging and anatomical classification of uterine fibroids,” Best Practice and Research, vol. 22, no. 4, pp. 627–642, 2008.
