Subscribe to RSS
DOI: 10.1055/s-2006-921424
© Georg Thieme Verlag Stuttgart · New York
Erstdiagnose eines serös-papillären Ovarialkarzinoms durch endosonographische Feinnadelaspirationsbiopsie eines submukösen Magentumors: ein Fallbericht
Primary Diagnosis of Serous Papillary Ovarian Carcinoma by EUS-Guided Fine-Needle Aspiration Biopsy of a Submucosal Gastric Tumor: A Case ReportPublication History
Publication Date:
15 March 2006 (online)
![](https://www.thieme-connect.de/media/endoheute/200601/lookinside/thumbnails/10.1055-s-2006-921424-1.jpg)
Zusammenfassung
Aufgrund eines rechtsseitigen hämorrhagischen Pleuraergusses mit zytologischem Nachweis von Tumorzellen wurde bei einer 39-jährigen Patientin eine Computertomographie durchgeführt. Dabei fand sich neben beidseitigen Pleuraergüssen, Aszites und möglichen kleinen Metastasen im rechten Lungenoberlappen eine solide Struktur von 2 × 3 × 4 cm ventral des Genu pancreatis, die sich nicht sicher vom Magenantrum differenzieren ließ. Diese Raumforderung, die als wahrscheinlicher Primärtumor angesehen wurde, führte gastroskopisch zu einer Pelottierung des hinterwandseitigen Magenantrum. Die Endosonographie konnte einen Pankreastumor oder einen anderen perigastralen Tumor ausschließen und die beschriebene Raumforderung als einen großen echoarmen, glatt konturierten submukösen Tumor mit Kontinuität zur Tunica muscularis charakterisieren. Die endosonographische Feinnadelaspirationsbiopsie führte zur histologischen Diagnose der Metastase eines Ovarialkarzinoms. Nachfolgende Untersuchungen und eine Laparatomie mit Hysterektomie, beidseitiger Salpingoovarektomie, Wedge-Resektion des Magentumors sowie Netzresektion bestätigten die Diagnose eines fortgeschritten metastasierten serös-papillären Ovarialkarzinoms mit Pleura- und Peritonealkarzinose sowie einer großen Metastase der Magenwand.
Abstract
A 39 years old woman with a right sided hemorrhagic pleural effusion and cytological evidence of tumour cells in the pleural fluid was further investigated by computed tomography. CT scans showed bilateral pleural effusions, ascites, suspicious small nodules in the upper lobus of the right lung, and a 2 × 3 × 4 cm solid tumour in the region between the pancreatic neck and the gastric antrum. This mass lesion was suspected to be the primary tumour. Endoscopically the tumour was found to impress the lumen of the gastric antrum. In endoscopic ultrasound (EUS) a pancreatic neoplasm or another extragastral mass lesion were excluded. A large hypoechoic submucosal tumour with distinct margins was found, which seemed to arise from the fourth hypoechoic (deep muscular) layer. EUS-guided fine-needle aspiration biopsy led to the histological diagnosis of metastasised ovarian carcinoma. Subsequent investigations and a laparatomy with hysterectomy, bilateral salpingo-oophorectomy, wedge resection of the gastric metastasis and resection of the omentum confirmed the diagnosis of an advanced serous papillary ovarian carcinoma with pleural and peritoneal carcinomatosis and with a large intramural metastasis of the stomach.
Schlüsselwörter
serös-papilläres Ovarialkarzinom - Magenwandmetastase - submuköser Tumor - endoskopischer Ultraschall - endosonographische Feinnadelpunktion
Key words
serous papillary ovarian carcinoma - gastric wall metastasis - submucosal tumor - endoscopic ultrasound - EUS-guided fine-needle aspiration biopsy
Literatur
- 1 Jenssen C, Dietrich C F. Endosonographie bei subepithelialen Tumoren des Verdauungstraktes. In: Dietrich CF (Hrsg). Endoskopischer Ultraschall - eine Einführung. Schnetztor-Verlag, Konstanz 2005; 98-138
- 2 Polkowski M. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors. Endoscopy. 2005; 37 635-645
- 3 Rosch T, Kapfer B, Will U, Baronius W, Strobel M, Lorenz R. et al . Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study. Scand J Gastroenterol. 2002; 37 856-862
- 4 Wiersema M J, Vilmann P, Giovannini M, Chang K J, Wiersema L M. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology. 1997; 112 1087-1095
- 5 Vander Noot M, Eloubeidi M A, Chen V K, Eltoum I, Jhala D, Jhala N. et al . Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer. 2004; 102 157-163
- 6 Ando N, Goto H, Niwa Y, Hirooka Y, Ohmiya N, Nagasaka T. et al . The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis. Gastrointest Endosc. 2002; 55 37-43
- 7 Okubo K, Yamao K, Nakamura T, Tajika M, Sawaki A, Hara K. et al . Endoscopic ultrasound-guided fine-needle aspiration biopsy for the diagnosis of gastrointestinal stromal tumors in the stomach. J Gastroenterol. 2004; 39 747-753
- 8 Mallery S, Lai R, Bardales R, Stelow E, Debol S, Stanley M. EUS-guided needle aspiration (EUS-FNA) in subepithelial GI-tract masses (SIGIM): results in 105 lesions [abstract]. Gastrointest Endosc. 2004; 59 AB 234
- 9 Green L K. Hematogenous metastases to the stomach. A review of 67 cases. Cancer. 1990; 65 1596-1600
- 10 Oda I, Kondo H, Yamao T, Saito D, Ono H, Gotoda T. et al . Metastatic tumors to the stomach: analysis of 54 patients diagnosed at endoscopy and 347 autopsy cases. Endoscopy. 2001; 33 507-510
- 11 Acs G, Pasha T, Zhang P J. WT1 is differentially expressed in serous, endometrioid, clear cell, and mucinous carcinomas of the peritoneum, fallopian tube, ovary, and endometrium. Int J Gynecol Pathol. 2004; 23 110-118
- 12 Goldstein N S, Bassi D, Uzieblo A. WT1 is an integral component of an antibody panel to distinguish pancreaticobiliary and some ovarian epithelial neoplasms. Am J Clin Pathol. 2001; 116 246-252
- 13 Hashi A, Yuminamochi T, Murata S, Iwamoto H, Honda T, Hoshi K. Wilms tumor gene immunoreactivity in primary serous carcinomas of the fallopian tube, ovary, endometrium, and peritoneum. Int J Gynecol Pathol. 2003; 22 374-377
- 14 Hwang H, Quenneville L, Yaziji H, Gown A M. Wilms tumor gene product: sensitive and contextually specific marker of serous carcinomas of ovarian surface epithelial origin. Appl Immunohistochem Mol Morphol. 2004; 12 122-126
- 15 Bloss J D, Liao S Y, Buller R E, Manetta A, Berman M L, McMeekin S. et al . Extraovarian peritoneal serous papillary carcinoma: a case-control retrospective comparison to papillary adenocarcinoma of the ovary. Gynecol Oncol. 1993; 50 347-351
- 16 Dalrymple J C, Bannatyne P, Russell P, Solomon H J, Tattersall M H, Atkinson K. et al . Extraovarian peritoneal serous papillary carcinoma. A clinicopathologic study of 31 cases. Cancer. 1989; 64 110-115
- 17 Piura B, Meirovitz M, Bartfeld M, Yanai-Inbar I, Cohen Y. Peritoneal papillary serous carcinoma: study of 15 cases and comparison with stage III-IV ovarian papillary serous carcinoma. J Surg Oncol. 1998; 68 173-178
- 18 Jenssen C, Siebert C, Bartho S. Leiomyosarcoma of the inferior vena cava, diagnosis by EUS - guided fine needle aspiration biopsy: a case report. Endoscopy. 2006; (submitted for publication)
- 19 Dong Q, McKee G, Pitman M, Geisinger K, Tambouret R. Epithelioid variant of gastrointestinal stromal tumor: Diagnosis by fine-needle aspiration. Diagn Cytopathol. 2003; 29 55-60
- 20 Fritscher-Ravens A, Sriram P V, Schroder S, Topalidis T, Bohnacker S, Soehendra N. Stromal tumor as a pitfall in EUS-guided fine-needle aspiration cytology. Gastrointest Endosc. 2000; 51 746-749
- 21 Sangha S, Gergeos F, Freter R, Paiva L L, Jacobson B C. Diagnosis of ovarian cancer metastatic to the stomach by EUS-guided FNA. Gastrointest Endosc. 2003; 58 933-935
Dr. C. Jenssen
Klinik für Innere Medizin · Krankenhaus Märkisch Oderland GmbH
Prötzeler Chaussee 5
15331 Strausberg
Phone: ++49/33 41/5 23 50
Fax: ++49/33 41/5 24 64
Email: c.jenssen@khmol.de