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Krukenberg Tumor
INTRODUCTION
Description: A Krukenberg tumor is a metastatic tumor
(generally from the gastrointestinal tract) that is characterized by large signet-ring cells. The most common site
or origin is the stomach or large intestine.
Predominant Age: Postmenopausal.
Genetics: No genetic pattern.
ETIOLOGY AND PATHOGENESIS
Causes: Metastatic spread of carcinoma from the
gastrointestinal tract (most commonly the stomach or
colon). Metastatic breast cancer may appear similar
histologically.
Risk Factors: None known.
CLINICAL CHARACTERISTICS
Signs and Symptoms
• Asymptomatic
• Adnexal enlargement (bilateral solid adnexal masses in
an older patient should always suggest the possibility of
a gastrointestinal tract source)
• Metastatic tumors from the gastrointestinal tract to the
ovary can be associated with sex hormone production,
usually estrogen.
DIAGNOSTIC APPROACH
Differential Diagnosis
• Benign adnexal masses (corpus luteum, follicular cyst)
• Endometriosis
• Hydrosalpinx
• Paratubal cyst
• Appendiceal abscess
• Ectopic pregnancy
• Pedunculated leiomyomata
• Pelvic or horseshoe kidney
• Nongynecologic pelvic masses
• Breast cancer
• Lung cancer
Associated Conditions: Gastrointestinal or breast
malignancy.
WORKUP AND EVALUATION
Laboratory: As indicated before surgery.
Imaging: Preoperative evaluation (computed tomography
or ultrasonography) for possible lymph node enlargement or intra-abdominal spread is indicated for patients
in whom malignancy is a significant possibility. Radiographic evaluation of the gastrointestinal tract. Mammography as indicated based on differential diagnosis
and routine screening needs.
Special Tests: Esophagoscopy, gastroscopy, sigmoidoscopy, or colonoscopy should be considered as a part of
the evaluation when a gastrointestinal source is being
sought.
Diagnostic Procedures: History, physical examination,
and imaging. Final diagnosis is established by histologic
evaluation.
Pathologic Findings
Nests of mucin-filled signet-ring cells in a cellular
stroma.
MANAGEMENT AND THERAPY
Nonpharmacologic
General Measures: Evaluation, establishment of location
of primary tumor (most often stomach or large
intestine).
Specific Measures: Therapy of the original tumor.
Diet: No specific dietary changes indicated except those
dictated by the original tumor and its therapy.
Activity: No restrictions except those dictated by the original tumor and its therapy.
Patient Education: American College of Obstetricians
and Gynecologists Patient Education Pamphlet AP096
(Cancer of the Ovary), AP075 (Ovarian Cysts).
Drug(s) of Choice
None (based on primary tumor and its therapy).
FOLLOW-UP
Patient Monitoring: Based on primary tumor.
Prevention/Avoidance: None.
Possible Complications: Progression and spread of the
primary tumor is generally well under way when the
ovarian sites are discovered.
Expected Outcome: Generally poor, with 5-year survival
unlikely.
MISCELLANEOUS
Pregnancy Considerations: Does not directly threaten
pregnancy except by the jeopardy caused to the
mother.
ICD-9-CM Codes: 198.6.
REFERENCES
Level II
de Palma P, Wronski M, Bifernino V, Bovani I: Krukenberg tumor
in pregnancy with virilization. A case report. Eur J Gynaecol Oncol
1995;16:59.
Kakushima N, Kamoshida T, Hirai S, et al: Early gastric cancer
with Krukenberg tumor and review of cases of intramucosal
gastric cancers with Krukenberg tumor. J Gastroenterol 2003;
38:1176.
Kuhlman JE, Hruban RH, Fishman EK: Krukenberg tumors:
CT features and growth characteristics. South Med J 1989;82:
1215.
Level III
Al-Agha OM, Nicastri AD: An in-depth look at Krukenberg tumor:
an overview. Arch Pathol Lab Med 2006;130:1725.
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332
SECTION 7 • Adnexal Disease
Primary focus—
carcinoma of the
stomach
Bilateral Krukenburg
tumors of the ovaries
Coleman RL, Gershenson DM: Neoplastic diseases of the ovary. In
Katz VL, Lentz GM, Lobo RA, Gershenson DM: Comprehensive
Gynecology, 5th ed. Philadelphia, Mosby/Elsevier, 2007:874.
Fleischer AC: Transabdominal and transvaginal sonography of
ovarian masses. Clin Obstet Gynecol 1991;34:433.
Young RH: From Krukenberg to today: the ever present problems
posed by metastatic tumors in the ovary: Part I. Historical perspec-
tive, general principles, mucinous tumors including the Krukenberg tumor. Adv Anat Pathol 2006;13:205.
Young RH: From Krukenberg to today: the ever present problems
posed by metastatic tumors in the ovary. Part II. Adv Anat Pathol
2007;14:149.