PMC4719221_01
a Scirrhus-type gastric cancer with ulcer. b Staging laparoscopy revealed serosal invasion of primary gastric cancer and peritoneal carcinomatosis involving omentum
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Fig1
The upper endoscopy showed scirrhous-type gastric cancer (Fig. 1a) with the biopsy result of moderately to poorly differentiated adenocarcinoma. A staging laparoscopy was performed also in our institution showing the tumor exposure to serosa of the stomach and the massive peritoneal carcinomatosis involving the greater omentum (Fig. 1b).
a Staging laparoscopy revealed peritoneal dissemination of gastric cancer in the whole intraperitoneal space. b Second-look laparoscopy showed the disappearance of peritoneal carcinomatosis after intraperitoneal chemotherapy. c Third-look laparoscopy showed sustained disappearance of peritoneal carcinomatosis but development of bilateral ovarian metastasis 4 years and 6 months after intraperitoneal chemotherapy started
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Fig2
Peritoneal disseminated nodules were found in whole intraabdominal space with a peritoneal cancer index (PCI) score of 23 (Fig. 2a). The disseminated peritoneal nodules had disappeared (Fig. 2b) and the washing cytology results had turned negative. However, bilateral enlarged ovaries were observed, which were considered to be Krukenberg metastasis (Fig. 2c).