Ovarian metastasis from gastrointestinal cancer

　　Most of the Krukenberg tumors in the ovarian metastasis of gastrointestinal cancer originate from the stomach, mainly explained by the fact that the functional and richly supplied ovaries are more suitable for the growth of metastatic tumors. The gross morphology of gastric cancer metastasis to the ovary generally maintains the original shape,呈肾形或卵圆形，with a smooth surface and no adhesion. Commonly seen are nodular elevations, with a complete but thin capsule, often grayish yellow or light brown, with a glossy appearance. The size of the tumor ranges from 3cm×3cm×3cm to 30cm×26cm×20cm, with bilateral cases accounting for the majority, and unilateral cases can also be seen. The cut surface shows a whitish tumor that is essentially solid, with moderate hardness and semi-transparent gelatinous consistency. There are necrosis, hemorrhage, and cystic changes within the tumor, forming small, sponge-like cavities of varying sizes, containing mucus or bloody fluid. It is rare for the entire tumor to be cystic.

　　Under the microscope, the appearance of the tumor cells is diverse, but the basic structure of each part is still relatively typical of mucinous cells, containing mucus, and showing positive staining with PAS and mucin carmine. The shape of the cells varies due to different amounts of mucus, with the quality and quantity of the tumor between the intestines and stomach varying, and its structure being dense and loose.

　　The stromal cells are arranged in clusters or crisscrossed around the tumor cell clusters, and some stromal cells present as sheet-like hyperplasia. Due to the large number of spindle-shaped cells covering the scattered signet ring cells among them, they are easily misdiagnosed as fibroma, mucinous fibroma, and so on. If the stromal cells are loose and have obvious edema, the nuclei are deeply and irregularly stained, they are easily misdiagnosed as sarcoma.

　　The percentage of gastrointestinal cancer metastasis to the ovary reported varies, from 20% to 67%, which is related to the inconsistency of the incidence of gastrointestinal cancer in different regions. The age of onset is mostly between 30 and 50 years, and the minimum age reported in the literature is 13 years, and the maximum age is 82 years.

　　The age of patients with ovarian metastasis is generally younger than that of primary ovarian cancer, and this phenomenon has been confirmed by many reports. Gu Renxun once reported that half of the cases were under the age of 40, Hwa reported an average age of 43.7 years, and Shi Yifu reported that 62% were between 30 and 45 years old. The conclusions reported by various experts are basically consistent.

　　Gastrointestinal cancer metastasis to the ovary mainly causes adhesions and infiltrations. Infiltration refers to the phenomenon that abnormal cells infiltrate the human tissue, or normal cells should not appear, and some pathological tissues expand to the surrounding area. The appearance of abnormal substances or excessive accumulation of some substances in the cells or stroma is also called infiltration. Some degeneration or precipitation is also called infiltration. Most infiltrations are pathological, but sometimes they are artificial for therapeutic purposes. Their effects on the body are very different. In inflammation, various inflammatory cells infiltrate the inflamed tissues, which is the body's defensive function against damage. Tumor cells can infiltrate the surrounding normal tissues, which is called tumor cell infiltration, and it is often a feature of malignant tumors. Infiltration can also be seen in treatment, in addition to the use of drug infiltration for therapeutic purposes and the infiltration of various inflammatory cells in inflammatory foci, any other infiltration is harmful to the body, and the extent of damage depends on the nature, amount of infiltrative substances, and the influence on the function of the affected organs.

　　Gastrointestinal cancer metastasis to the ovary, like other early ovarian cancers, is often asymptomatic and often accompanied by symptoms of the primary lesion. Patients with primary gastrointestinal cancer may have abdominal pain, bloating, intestinal symptoms, or weight loss; patients with primary endometrial cancer may have irregular vaginal bleeding or an increase in leukorrhea, and the symptoms of secondary tumors are usually more prominent than those of primary tumors. Many people seek medical attention with pelvic symptoms, especially abdominal pain and masses.

　　There are many cases of ascites in ovarian cancer with metastasis. Interstitial edema and lymphatic tumor thrombi are often visible in pathological examination, and it is estimated that lymphatic obstruction and tumor exudate are the main reasons for the formation of ascites. In some cases, the tumor tissue of the omentum and peritoneum may be present due to metastasis, or it may be caused by hypoproteinemia. Shi Yifu once reported that 80% of the cases had ascites, the maximum amount of ascites reached 9000ml, and more than 500ml accounted for 60%, and ascites with yellow and hemorrhagic color were more common. There was also one case of chyle ascites, in which half of the cases found signet ring cells in the cytological examination of ascites, and the karyotype examination of ascites was also aneuploid, with both numerical and structural abnormalities.

　　Almost all cases can be palpated for abdominal masses. Among them, many are palpated by the patients themselves, and the rest are found during medical examination. Some are difficult to detect during pelvic examination due to不明显 enlargement of the ovary or thickened abdominal wall, but it is not difficult to detect by B-ultrasound, especially vaginal B-ultrasound..

　　Only a small part of patients with metastatic ovarian tumors have a history and symptoms of primary tumors, and then appear symptoms of ovarian metastatic tumors, but many patients have not paid attention to the symptoms of the primary lesion due to atypical symptoms, so they seek medical attention due to the symptoms of the metastatic tumor. Shi Yifu (1988) reported that 48.6% had a history of gastric cancer, 13.5% had a history of gastric ulcer, 35.1% had a自觉

     The preoperative diagnostic rate of ovarian metastatic tumors is not high. Actively preventing and treating female gastrointestinal primary tumors is beneficial for reducing the incidence of ovarian metastatic tumors and extending survival. Female patients with gastrointestinal tumors should regularly perform gynecological follow-up work to prevent the occurrence and development of gastrointestinal cancer metastasis to the ovary. For those who have already developed metastasis, active treatment and follow-up work should be done.

　　Patients with gastrointestinal cancer metastasis to the ovary should drink plenty of water and eat more fresh fruits, vegetables, and foods with anti-external genital tumor effects, such as sesame seeds, almonds, wheat, loofah, barley, black-bone chicken, cuttlefish, pork pancreas, blacksnake, chrysanthemum, umeboshi, lychee, peach, purslane, eel, chicken blood, abalone, crab, horseshoe crab, sardine, clam, clam, and tortoise; those with pain symptoms should eat horseshoe crab, red, sea cucumber, lobster, scallops, tiger fish, beetroot, mung bean, radish, chicken blood; those with itching symptoms should eat amaranth, mustard, taro, kelp, cabbage, nori, chicken blood, snake meat, and pangolin; foods that should be avoided include fish, shrimp, crab, chicken head, pork head meat, goose meat, chicken wings, and chicken feet, etc.; avoid sour and astringent foods to prevent blood stasis. Avoid eating fried and greasy foods.

　　For patients with gastrointestinal cancer metastasis to the ovary whose general condition is still good and who can tolerate surgery, it is still necessary to actively perform surgery because the postoperative diagnosis can be clear. Due to the difficulty in determining the primary or secondary before surgery, if it is primary and surgery is not performed, the patient will lose the opportunity for treatment. Resection of secondary metastatic tumors is also beneficial for reducing compression, inhibiting the production of ascites, alleviating symptoms, and so on. Based on exploration, the location and nature of the primary tumor can be clearly identified, and it can be estimated whether it can be resected, which does not increase a lot of burden on the patient. Striving to resect the primary lesion at the same time will be better for the prognosis. Simple resection of metastatic tumors has a poor prognosis, is prone to recurrence, and can lead to death.

　　The scope of gynecological surgery varies according to the patient's condition. Generally, it can be a total hysterectomy and bilateral adnexectomy, and the omentum can be partially or resected below the transverse colon; if the patient's physical condition is poor or abdominal metastasis is found during surgery, bilateral adnexectomy can be performed; if the primary lesion can be resected or has been resected but has pelvic limited metastasis, a total hysterectomy with bilateral adnexectomy can be performed, and the pelvic metastatic tumors should be resected as much as possible at the same time.If the primary tumor is not large, the metastasis is not obvious, and the patient's condition is good, it is still necessary to actively strive for simultaneous surgical resection. However, in clinical practice, many patients find it difficult to achieve the resection of the primary lesion..

　　After gynecological surgery, appropriate anti-cancer drugs for chemotherapy can be selected according to the location and nature of the primary cancer. For cancer masses that have metastasized to the ovary from the gastrointestinal tract, chemotherapy commonly used includes fluorouracil (5-FU), mitomycin (MMC), cisplatin (DDP), and so on. Radiotherapy generally has no significant effect.