Krukenberg tumour

Definition

Krukenberg tumour

• Krukenberg tumour: The Krukenberg tumour is a bilateral ovarian metastasis with signet ring cells, most commonly from gastric cancer.

• Krukenberg tumour is an ovarian metastasis of signet-ring cell carcinoma, mostly from the gastrointestinal tract and in about 76% from the stomach.
• Less often the primary lies in the appendix, breast, colon, small bowel, gallbladder, pancreas or genitourinary tract; occasionally it is not found.

Occurrence & epidemiology

Epidemiology

• About 10% of ovarian tumours are metastases, nearly half of them Krukenberg tumours; the proportion is higher in Japan, Korea and China because gastric cancer is more common there.
• Patients tend to be young, with an average age of about 45 years.

Aetiopathogenesis

Spread

• Spread is often lymphatic, via retrograde lymphatic spread in gastric cancer, but may also be haematogenous or by direct invasion.

Clinical features

• Abdominal pain and distension are common, as are bloating, ascites, irregular vaginal bleeding and dyspareunia; the ovarian symptoms may be the first sign of the cancer.
• The remaining patients have non-specific gastrointestinal complaints or are asymptomatic.
• Ascites is present in about half of cases and usually contains malignant cells; changes in the ovarian stroma can lead to hormone production.

Histology

• Signet-ring cells with pale cytoplasm lie singly or in nests within the ovarian stroma; a sarcoma-like stromal reaction is typical, and the stroma may also be luteinised.
• Signet-ring cells are highly specific for a metastatic origin, but they may rarely occur in primary mucinous ovarian carcinomas as well.

Diagnosis

• Ultrasound and CT usually show bilateral solid ovarian masses, less often cystic ones; both ovaries are involved in about 80%.
• The primary tumour is often very small and requires careful radiological and endoscopic search.

Keep learning in the app

Further reading (selection)

1. StatPearls: Krukenberg Tumor
2. Krukenberg tumor presenting as back pain and a positive urine pregnancy test: a case report and literature review (J Ovarian Res 2014, PubMed Central)
3. Primary mucinous ovarian tumors vs. ovarian metastases from gastrointestinal tract, pancreas and biliary tree: a review of current problematics (Diagn Pathol 2021, PubMed Central)
4. DocCheck Flexikon, Ovarialtumor

Cross-references