Krukenberg tumor: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Soujanya Thummathati (talk | contribs)
CMEUser, nocaptcha
1,519 edits
No edit summary
Soujanya Thummathati (talk | contribs)
CMEUser, nocaptcha
1,519 edits
No edit summary
Line 17: Line 17:
{{CMG}} {{AE}} {{STM}}
{{CMG}} {{AE}} {{STM}}
   
   
{{SK}} carcinoma mucocellulare; Synonym 2; Synonym 3
{{SK}} carcinoma mucocellulare; Ovarian tumor
   
   
==Overview==
==Overview==
Krukenberg's tumor  is a rare metastatic signet ring cell adenocarcinoma of the ovary.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
Krukenberg's tumor  is a rare metastatic [[signet ring cell]] [[adenocarcinoma]] of the [[ovary]].<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>


==Historical Perspective==
==Historical Perspective==
*Krukenberg's tumor was first described as a new type of primary ovarian malignancy by Friedrich Ernst Krukenberg (1871–1946), a German gynecologist and pathologist, in 1896 which was later confirmed to be of metastatic gastrointestinal tract origin.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*Krukenberg's tumor was first described as a new type of primary ovarian [[malignancy]] by [[Friedrich Ernst Krukenberg]] (1871–1946), a German gynecologist and pathologist, in 1896 which was later confirmed to be of metastatic [[gastrointestinal tract]] origin.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
   
   
==Pathophysiology==
==Pathophysiology==
*The majority of Krukenberg’s tumors are bilateral.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*The majority of Krukenberg’s tumors are bilateral.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*Stomach is the primary site in the majority of Krukenberg tumor cases (70%).<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*[[Stomach]] and colon are the primary sites in the majority of Krukenberg tumor cases (70%).<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*The pathogenesis of krukenberg tumors is from metastasis of tumor cells from the stomach, appendix or colon to the ovaries.<ref name=jh>Krukenberg tumor. Wikipedia. https://en.wikipedia.org/wiki/Krukenberg_tumor#cite_note-Young2006-4 Accessed on March 21, 2016.</ref>
*The pathogenesis of krukenberg tumors involves [[metastasis]] of [[tumor]] cells from the [[stomach]], [[appendix]] or [[colon]] to the [[ovaries]].<ref name=jh>Krukenberg tumor. Wikipedia. https://en.wikipedia.org/wiki/Krukenberg_tumor#cite_note-Young2006-4 Accessed on March 21, 2016.</ref>
**Metastasis is more likely via the lymphatic spread. However, direct seeding across the abdominal cavity may also occur.
**[[Metastasis]] is more likely via the [[lymphatic]] spread. However, direct seeding across the [[abdominal cavity]] may also occur.
*On gross pathology, asymmetrically enlarged ovaries with a bosselated contour, usually solid, yellow or white cross sectioned surfaces, and the absence of adhesions or peritoneal deposits are characteristic findings of krukenberg tumors.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*On [[gross pathology]], asymmetrically enlarged ovaries with a bosselated contour, usually solid, yellow or white cross sectioned surfaces, and the absence of adhesions or [[peritoneal]] deposits are characteristic findings of krukenberg tumors.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*On microscopic histopathological analysis, krukenberg tumors are characterized by the following features:
*On microscopic histopathological analysis, krukenberg tumors are characterized by the following features:
**Tumor composed of two components:
**[[Tumor]] composed of two components:
***Epithelial  
***[[Epithelial]]
****Mucin-secreting signet ring cells with eccentric hyperchromatic nuclei
****[[Mucin]]-secreting [[signet ring cell]]s with eccentric [[hyperchromatic nuclei]]
****Cytoplasm may be eosinophilic and granular, pale and vacuolated, or a bull's eye (targetoid) appearance with a large vacuole with a central to paracentral eosinophilic body composed of a droplet of mucin
****[[Cytoplasm]] may be [[eosinophilic]] and granular, pale and vacuolated, or a bull's eye (targetoid) appearance with a large vacuole with a central to paracentral eosinophilic body composed of a droplet of [[mucin]]
****Signet ring cells may be single, clustered, nested, or arranged in tubules, acini, trabeculae, or cords
****[[Signet ring cell]]s may be single, clustered, nested, or arranged in tubules, acini, trabeculae, or cords
***Stromal
***Stromal
**** Plump and spindle-shaped cells with minimal cytologic atypia or mitotic activity
**** Plump and spindle-shaped cells with minimal cytologic [[atypia]] or [[mitotic activity]]
****Focal or diffuse stromal edema which may form pseudo cysts  
****Focal or diffuse stromal [[edema]] which may form pseudo cysts  
****Desmoplastic reaction may be present
****[[Desmoplastic reaction]] may be present
*Stomach is the primary site in the majority of Krukenberg tumor cases (70%).<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*[[Stomach]] is the primary site in the majority of Krukenberg tumor cases (70%).<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
   
   
==Causes==
==Causes==
* Krukenberg's tumor may be caused by metastasis of the tumor cells from a primary cancer in the stomach, appendix, or the colon via:<ref name=jh>Krukenberg tumor. Wikipedia. https://en.wikipedia.org/wiki/Krukenberg_tumor#cite_note-Young2006-4 Accessed on March 21, 2016.</ref>
* Krukenberg's tumor may be caused by [[metastasis]] of the [[tumor]] cells from a primary cancer in the stomach, [[appendix]], or the [[colon]] via:<ref name=jh>Krukenberg tumor. Wikipedia. https://en.wikipedia.org/wiki/Krukenberg_tumor#cite_note-Young2006-4 Accessed on March 21, 2016.</ref>
**Lymphatic spread; or
**[[Lymphatic]] spread; or
**Direct seeding across the abdominal cavity
**Direct seeding across the [[abdominal cavity]]


==Differentiating [disease name] from other Diseases==
==Differentiating [disease name] from other Diseases==
*Krukenberg's tumor must be differentiated from the following:<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*Krukenberg's tumor must be differentiated from the following:<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
:*Primary mucinous carcinoma
:*[[Primary mucinous carcinoma]]
:*Mucinous carcinoid tumor
:*[[Mucinous carcinoid tumor]]
:*Signet ring stromal tumor
:*[[Signet ring stromal tumor]]
:*Sclerosing stromal cell tumor
:*[[Sclerosing stromal cell tumor]]
:*Clear cell adenocarcinoma of the ovary
:*Clear cell [[adenocarcinoma]] of the [[ovary]]
:*Sertoli-Leydig cell tumor
:*[[Sertoli-Leydig cell tumor]]
   
   
==Epidemiology and Demographics==
==Epidemiology and Demographics==
===Incidence===
===Incidence===
*The incidence of [disease name] is estimated to be approximately 0.16 per 100,000 individuals.<ref name="pmid23024922">{{cite journal| author=Tellier F, Steibel J, Chabrier R, Blé FX, Tubaldo H, Rasata R et al.| title=Sentinel lymph nodes fluorescence detection and imaging using Patent Blue V bound to human serum albumin. | journal=Biomed Opt Express | year= 2012 | volume= 3 | issue= 9 | pages= 2306-16 | pmid=23024922 | doi=10.1364/BOE.3.002306 | pmc=PMC3447570 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23024922  }} </ref><ref name=ok>Krukenberg tumour. Radiopedia. Accessed on March 23, 2016.</ref>
*The [[incidence]] of krukenberg tumors is estimated to be approximately 0.16 per 100,000 individuals.<ref name="pmid23024922">{{cite journal| author=Tellier F, Steibel J, Chabrier R, Blé FX, Tubaldo H, Rasata R et al.| title=Sentinel lymph nodes fluorescence detection and imaging using Patent Blue V bound to human serum albumin. | journal=Biomed Opt Express | year= 2012 | volume= 3 | issue= 9 | pages= 2306-16 | pmid=23024922 | doi=10.1364/BOE.3.002306 | pmc=PMC3447570 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23024922  }} </ref><ref name=ok>Krukenberg tumour. Radiopedia. Accessed on March 23, 2016.</ref>
   
   
===Age===
===Age===
*Patients of all age groups may develop krukenberg tumors.
*Patients of all age groups may develop krukenberg tumors.
*Krukenberg's tumor is more commonly observed among women in their fifth decade of lives, with anaverage around 45 years of age.
*Krukenberg's tumor is more commonly observed among women in their fifth decade of lives, with an average around 45 years of age.
   
   
==Risk Factors==
==Risk Factors==
*There are no known direct causes for krukenberg tumors. Common risk factors for ovarian cancer may include:<ref>Ovarian cancer. Wikipedia. https://en.wikipedia.org/wiki/Ovarian_cancer#Genetics Accessed on March 23, 2016.</ref>
*There are no known direct causes for krukenberg tumors. Common risk factors for ovarian cancer may include:<ref>Ovarian cancer. Wikipedia. https://en.wikipedia.org/wiki/Ovarian_cancer#Genetics Accessed on March 23, 2016.</ref>
**Nulliparity
**[[Nulliparity]]
**Early menarche
**Early [[menarche]]
**Late menopause
**Late [[menopause]]
**Hormone therapy
**[[Hormone therapy]]
**Fertility medications
**[[Fertility medication]]s
   
   
==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
*The majority of patients with krukenberg tumor remain asymptomatic or have non-specific gastrointestinal symptoms.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*The majority of patients with krukenberg tumor remain asymptomatic or have non-specific [[gastrointestinal]] symptoms.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*Early clinical features include abdominal pain and distension(from the large, bilateral ovarian masses).<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*Early clinical features include abdominal pain and distension(from the large, bilateral [[ovarian mass]]es).<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*If left untreated, patients with krukenberg tumors may progress to develop virilization from the excessive hormone production from the ovarian stroma.<ref name="pmid18279511">{{cite journal| author=Hornung M, Vogel P, Schubert T, Schlitt HJ, Bolder U| title=A case of virilization induced by a Krukenberg tumor from gastric cancer. | journal=World J Surg Oncol | year= 2008 | volume= 6 | issue=  | pages= 19 | pmid=18279511 | doi=10.1186/1477-7819-6-19 | pmc=PMC2275731 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18279511  }} </ref>
*If left untreated, patients with krukenberg tumors may progress to develop [[virilization]] from the excessive hormone production from the ovarian stroma.<ref name="pmid18279511">{{cite journal| author=Hornung M, Vogel P, Schubert T, Schlitt HJ, Bolder U| title=A case of virilization induced by a Krukenberg tumor from gastric cancer. | journal=World J Surg Oncol | year= 2008 | volume= 6 | issue=  | pages= 19 | pmid=18279511 | doi=10.1186/1477-7819-6-19 | pmc=PMC2275731 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18279511  }} </ref>
*Common complications of [disease name] include ascites, virilization, and pseudo-Meig syndrome.<ref name="pmid18279511">{{cite journal| author=Hornung M, Vogel P, Schubert T, Schlitt HJ, Bolder U| title=A case of virilization induced by a Krukenberg tumor from gastric cancer. | journal=World J Surg Oncol | year= 2008 | volume= 6 | issue=  | pages= 19 | pmid=18279511 | doi=10.1186/1477-7819-6-19 | pmc=PMC2275731 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18279511  }} </ref><ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*Common complications of krukenberg tumors include [[ascites]], [[virilization]], and [[pseudo-Meig syndrome]].<ref name="pmid18279511">{{cite journal| author=Hornung M, Vogel P, Schubert T, Schlitt HJ, Bolder U| title=A case of virilization induced by a Krukenberg tumor from gastric cancer. | journal=World J Surg Oncol | year= 2008 | volume= 6 | issue=  | pages= 19 | pmid=18279511 | doi=10.1186/1477-7819-6-19 | pmc=PMC2275731 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18279511  }} </ref><ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
**Pseudo-Meig syndrome is defined as a hydrothorax with ascites, but with the absence of tumor cells.  
**[[Pseudo-Meig syndrome]] is defined as a [[hydrothorax]] with [[ascites]], but with the absence of [[tumor]] cells.  
*Prognosis is generally poor, and the 5 ­year survival rate of patients with krukenberg tumor is lower in patients in with a preoperative serum CA 125 levels greater than 75 U/mL when compared with patients with CA 125 levels less than 75 U/mL.<ref name="pmid25830046">{{cite journal| author=Khan M, Bhatti RP, Mukherjee S, Ali AM, Gilman AD, Mirrakhimov AE et al.| title=A 26-year-old female with metastatic primary gastrointestinal malignancy presenting as menorrhagia. | journal=J Gastrointest Oncol | year= 2015 | volume= 6 | issue= 2 | pages= E21-5 | pmid=25830046 | doi=10.3978/j.issn.2078-6891.2014.080 | pmc=PMC4311099 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25830046  }} </ref> The median survival of patients is between 7 to 14 months.<ref name="pmid18279511">{{cite journal| author=Hornung M, Vogel P, Schubert T, Schlitt HJ, Bolder U| title=A case of virilization induced by a Krukenberg tumor from gastric cancer. | journal=World J Surg Oncol | year= 2008 | volume= 6 | issue=  | pages= 19 | pmid=18279511 | doi=10.1186/1477-7819-6-19 | pmc=PMC2275731 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18279511  }} </ref>
*[[Prognosis]] is generally poor, and the 5 ­year survival rate of patients with krukenberg tumor is lower in patients in with a preoperative serum [[CA 125]] levels greater than 75 U/mL when compared with patients with [[CA 125]] levels less than 75 U/mL.<ref name="pmid25830046">{{cite journal| author=Khan M, Bhatti RP, Mukherjee S, Ali AM, Gilman AD, Mirrakhimov AE et al.| title=A 26-year-old female with metastatic primary gastrointestinal malignancy presenting as menorrhagia. | journal=J Gastrointest Oncol | year= 2015 | volume= 6 | issue= 2 | pages= E21-5 | pmid=25830046 | doi=10.3978/j.issn.2078-6891.2014.080 | pmc=PMC4311099 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25830046  }} </ref> The median survival of patients is between 7 to 14 months.<ref name="pmid18279511">{{cite journal| author=Hornung M, Vogel P, Schubert T, Schlitt HJ, Bolder U| title=A case of virilization induced by a Krukenberg tumor from gastric cancer. | journal=World J Surg Oncol | year= 2008 | volume= 6 | issue=  | pages= 19 | pmid=18279511 | doi=10.1186/1477-7819-6-19 | pmc=PMC2275731 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18279511  }} </ref>
   
   
==Diagnosis==
==Diagnosis==
Line 86: Line 86:
*Symptoms of krukenberg tumors may include the following:<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref><ref name=jh>Krukenberg tumor. Wikipedia. https://en.wikipedia.org/wiki/Krukenberg_tumor#cite_note-Young2006-4 Accessed on March 21, 2016.</ref>
*Symptoms of krukenberg tumors may include the following:<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref><ref name=jh>Krukenberg tumor. Wikipedia. https://en.wikipedia.org/wiki/Krukenberg_tumor#cite_note-Young2006-4 Accessed on March 21, 2016.</ref>
:*Non-specific gastrointestinal symptoms
:*Non-specific gastrointestinal symptoms
:*Abdominal or pelvic pain
:*Abdominal or [[pelvic]] pain
:*Abdominal distension
:*Abdominal distension
:*Bloating
:*[[Bloating]]
:*Dyspareunia
:*[[Dyspareunia]]
:*Vaginal bleeding
:*[[Vaginal bleeding]]
:*Menstrual irregularities
:*Menstrual irregularities
:*Hirsutism
:*[[Hirsutism]]


===Physical Examination===
===Physical Examination===
Line 98: Line 98:
*Physical examination may be remarkable for:<ref name=jh>Krukenberg tumor. Wikipedia. https://en.wikipedia.org/wiki/Krukenberg_tumor#cite_note-Young2006-4 Accessed on March 21, 2016.</ref><ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*Physical examination may be remarkable for:<ref name=jh>Krukenberg tumor. Wikipedia. https://en.wikipedia.org/wiki/Krukenberg_tumor#cite_note-Young2006-4 Accessed on March 21, 2016.</ref><ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
:*Abdominal or pelvic mass
:*Abdominal or pelvic mass
:*Ascites
:*[[Ascites]]
:*Hirsutism
:*[[Hirsutism]]


===Laboratory Findings===
===Laboratory Findings===
Line 106: Line 106:
===Imaging Findings===
===Imaging Findings===
====X Ray====
====X Ray====
*On x rays, krukenberg tumor may present with the following findings:<ref name=ok>Krukenberg tumour. Radiopedia. http://radiopaedia.org/articles/krukenberg-tumour-1 Accessed on March 23, 2016.</ref>
**Prominent [[small bowel]] loops filled with gas
**No air-fluid level
**No radiographic signs of [[intestinal obstruction]]
<gallery>
<gallery>
Image:krukenberg-tumour-2 (6).jpg|X ray showing prominent small bowel loops filled with gas, no air-fluid level, no radiographic signs of intestinal obstruction<ref name=op>Image courtesy of Dr Hani Al Salam. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/krukenberg-tumour-2 ‘’here’’]). [http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:krukenberg-tumour-2 (6).jpg|X ray showing prominent small bowel loops filled with gas, no air-fluid level, no radiographic signs of intestinal obstruction<ref name=op>Image courtesy of Dr Hani Al Salam. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/krukenberg-tumour-2 ‘’here’’]). [http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Line 113: Line 118:
*On pelvic ultrasound, krukenberg tumor is characterized by the following:<ref name="pmid23024922">{{cite journal| author=Tellier F, Steibel J, Chabrier R, Blé FX, Tubaldo H, Rasata R et al.| title=Sentinel lymph nodes fluorescence detection and imaging using Patent Blue V bound to human serum albumin. | journal=Biomed Opt Express | year= 2012 | volume= 3 | issue= 9 | pages= 2306-16 | pmid=23024922 | doi=10.1364/BOE.3.002306 | pmc=PMC3447570 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23024922  }} </ref></ref><ref name=ok>Krukenberg tumour. Radiopedia. http://radiopaedia.org/articles/krukenberg-tumour-1 Accessed on March 23, 2016.</ref>
*On pelvic ultrasound, krukenberg tumor is characterized by the following:<ref name="pmid23024922">{{cite journal| author=Tellier F, Steibel J, Chabrier R, Blé FX, Tubaldo H, Rasata R et al.| title=Sentinel lymph nodes fluorescence detection and imaging using Patent Blue V bound to human serum albumin. | journal=Biomed Opt Express | year= 2012 | volume= 3 | issue= 9 | pages= 2306-16 | pmid=23024922 | doi=10.1364/BOE.3.002306 | pmc=PMC3447570 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23024922  }} </ref></ref><ref name=ok>Krukenberg tumour. Radiopedia. http://radiopaedia.org/articles/krukenberg-tumour-1 Accessed on March 23, 2016.</ref>
**Bilateral, solid ovarian masses with clear, well defined margins
**Bilateral, solid ovarian masses with clear, well defined margins
**An irregular hyper-echoic solid pattern and moth eaten like cyst formation is also considered a characteristic feature  
**An irregular hyper-echoic solid pattern and moth eaten like [[cyst]] formation is also considered a characteristic feature  


<Gallery>
<Gallery>
Line 127: Line 132:
====CT====
====CT====
*On CT, krukenberg tumor is characterized by the following:<ref name=ok>Krukenberg tumour. Radiopedia. http://radiopaedia.org/articles/krukenberg-tumour-1 Accessed on March 23, 2016.</ref><ref name="pmid2992252">{{cite journal| author=Cho KC, Gold BM| title=Computed tomography of Krukenberg tumors. | journal=AJR Am J Roentgenol | year= 1985 | volume= 145 | issue= 2 | pages= 285-8 | pmid=2992252 | doi=10.2214/ajr.145.2.285 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2992252  }} </ref>
*On CT, krukenberg tumor is characterized by the following:<ref name=ok>Krukenberg tumour. Radiopedia. http://radiopaedia.org/articles/krukenberg-tumour-1 Accessed on March 23, 2016.</ref><ref name="pmid2992252">{{cite journal| author=Cho KC, Gold BM| title=Computed tomography of Krukenberg tumors. | journal=AJR Am J Roentgenol | year= 1985 | volume= 145 | issue= 2 | pages= 285-8 | pmid=2992252 | doi=10.2214/ajr.145.2.285 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2992252  }} </ref>
**Large, lobulated, and multicystic masses with soft-tissue components which are indistinguishable from primary ovarian cancers
**Large, lobulated, and multicystic masses with [[soft-tissue]] components which are indistinguishable from [[primary ovarian cancer]]s
**Presence of a concurrent gastric or colic mural lesion
**Presence of a concurrent [[gastric]] or [[colic]] mural lesion


<Gallery>
<Gallery>
Line 138: Line 143:
**Bilateral complex masses with hypo-intense solid components (dense stromal reaction)
**Bilateral complex masses with hypo-intense solid components (dense stromal reaction)
**Internal hyperintensity (mucin) on T1 and T2 weighted MR images
**Internal hyperintensity (mucin) on T1 and T2 weighted MR images
**Strong contrast enhancement is usually seen in the solid component or the wall of the intratumoral cyst
**Strong contrast enhancement is usually seen in the solid component or the wall of the intratumoral [[cyst]]


<Gallery>
<Gallery>
Line 154: Line 159:
=== Other Diagnostic Studies ===
=== Other Diagnostic Studies ===
====Immunohistochemistry====
====Immunohistochemistry====
*Krukenberg's tumor may also be diagnosed using immunohistochemistry.
*Krukenberg's tumor may also be diagnosed using [[immunohistochemistry]].<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*Findings on immunohistochemistry include:
*Findings on [[immunohistochemistry]] include:
**Cytokeratins (AE1/AE3) positive
**Cytokeratins (AE1/AE3) positive
**Epithelial membrane antigen positive
**Epithelial membrane antigen positive
**Vimentin negative
**[[Vimentin]] negative
**Inhibin negative
**[[Inhibin]] negative


====Serum CA-125====
====Serum CA-125====
*Serum concentrations of CA 125 may be helpful  for:<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*Serum concentrations of [[CA 125]] may be helpful  for:<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
**Post-operative follow-up of patients for evaluation of complete resection of the tumor
**Post-operative follow-up of patients for evaluation of complete resection of the [[tumor]]
**Follow-up of patients with a history of primary adenocarcinomas (particularly gastrointestinal) for early detection of ovarian metastasis
**Follow-up of patients with a history of [[primary adenocarcinoma]]s (particularly gastrointestinal) for early detection of [[ovarian metastasis]]
   
   
== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*Management of krukenberg tumors is driven by the identification and treatment of the primary cancer.
*Management of krukenberg tumors is driven by the identification and treatment of the primary cancer.
*Chemotherapy/radiation has no significant effect on the prognosis of patients with Krukenberg tumors.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
*[[Chemotherapy]]/[[radiation]] has no significant effect on the prognosis of patients with Krukenberg tumors.<ref name="pmid17076540">{{cite journal| author=Al-Agha OM, Nicastri AD| title=An in-depth look at Krukenberg tumor: an overview. | journal=Arch Pathol Lab Med | year= 2006 | volume= 130 | issue= 11 | pages= 1725-30 | pmid=17076540 | doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17076540  }} </ref>
    
    
=== Surgery ===
=== Surgery ===
*Bilateral oophorectomy may only be performed for patients where the metastasis is localized to the ovaries.<ref name="pmid20018420">{{cite journal| author=Kim WY, Kim TJ, Kim SE, Lee JW, Lee JH, Kim BG et al.| title=The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries. | journal=Eur J Obstet Gynecol Reprod Biol | year= 2010 | volume= 149 | issue= 1 | pages= 97-101 | pmid=20018420 | doi=10.1016/j.ejogrb.2009.11.011 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20018420  }} </ref>
*Bilateral [[oophorectomy]] may only be performed for patients where the [[metastasis]] is localized to the ovaries.<ref name="pmid20018420">{{cite journal| author=Kim WY, Kim TJ, Kim SE, Lee JW, Lee JH, Kim BG et al.| title=The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries. | journal=Eur J Obstet Gynecol Reprod Biol | year= 2010 | volume= 149 | issue= 1 | pages= 97-101 | pmid=20018420 | doi=10.1016/j.ejogrb.2009.11.011 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20018420  }} </ref>
*The significance of early detection of ovarian metastasis and the importance of monitoring serum CA 125 level may improve the prognosis.
*The significance of early detection of ovarian [[metastasis]] and the importance of monitoring serum [[CA 125]] level may improve the prognosis.
*Surgical resection may not be an option if the tumor has already metastasized to other sites.
*Surgical resection may not be an option if the [[tumor]] has already metastasized to other sites.
   
   
=== Prevention ===
=== Prevention ===

Revision as of 19:21, 22 March 2016

Krukenberg tumor
Krukenberg tumor
ICD-10 C56
ICD-9 183
ICD-O: 8490/6
DiseasesDB 30081
MeSH C04.557.470.200.025.415.410

WikiDoc Resources for Krukenberg tumor

Articles

Most recent articles on Krukenberg tumor

Most cited articles on Krukenberg tumor

Review articles on Krukenberg tumor

Articles on Krukenberg tumor in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Krukenberg tumor

Images of Krukenberg tumor

Photos of Krukenberg tumor

Podcasts & MP3s on Krukenberg tumor

Videos on Krukenberg tumor

Evidence Based Medicine

Cochrane Collaboration on Krukenberg tumor

Bandolier on Krukenberg tumor

TRIP on Krukenberg tumor

Clinical Trials

Ongoing Trials on Krukenberg tumor at Clinical Trials.gov

Trial results on Krukenberg tumor

Clinical Trials on Krukenberg tumor at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Krukenberg tumor

NICE Guidance on Krukenberg tumor

NHS PRODIGY Guidance

FDA on Krukenberg tumor

CDC on Krukenberg tumor

Books

Books on Krukenberg tumor

News

Krukenberg tumor in the news

Be alerted to news on Krukenberg tumor

News trends on Krukenberg tumor

Commentary

Blogs on Krukenberg tumor

Definitions

Definitions of Krukenberg tumor

Patient Resources / Community

Patient resources on Krukenberg tumor

Discussion groups on Krukenberg tumor

Patient Handouts on Krukenberg tumor

Directions to Hospitals Treating Krukenberg tumor

Risk calculators and risk factors for Krukenberg tumor

Healthcare Provider Resources

Symptoms of Krukenberg tumor

Causes & Risk Factors for Krukenberg tumor

Diagnostic studies for Krukenberg tumor

Treatment of Krukenberg tumor

Continuing Medical Education (CME)

CME Programs on Krukenberg tumor

International

Krukenberg tumor en Espanol

Krukenberg tumor en Francais

Business

Krukenberg tumor in the Marketplace

Patents on Krukenberg tumor

Experimental / Informatics

List of terms related to Krukenberg tumor

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soujanya Thummathati, MBBS [2]

Synonyms and keywords: carcinoma mucocellulare; Ovarian tumor

Overview

Krukenberg's tumor is a rare metastatic signet ring cell adenocarcinoma of the ovary.[1]

Historical Perspective

Pathophysiology

  • The majority of Krukenberg’s tumors are bilateral.[1]
  • Stomach and colon are the primary sites in the majority of Krukenberg tumor cases (70%).[1]
  • The pathogenesis of krukenberg tumors involves metastasis of tumor cells from the stomach, appendix or colon to the ovaries.[2]
  • On gross pathology, asymmetrically enlarged ovaries with a bosselated contour, usually solid, yellow or white cross sectioned surfaces, and the absence of adhesions or peritoneal deposits are characteristic findings of krukenberg tumors.[1]
  • On microscopic histopathological analysis, krukenberg tumors are characterized by the following features:
  • Stomach is the primary site in the majority of Krukenberg tumor cases (70%).[1]

Causes

Differentiating [disease name] from other Diseases

  • Krukenberg's tumor must be differentiated from the following:[1]

Epidemiology and Demographics

Incidence

  • The incidence of krukenberg tumors is estimated to be approximately 0.16 per 100,000 individuals.[3][4]

Age

  • Patients of all age groups may develop krukenberg tumors.
  • Krukenberg's tumor is more commonly observed among women in their fifth decade of lives, with an average around 45 years of age.

Risk Factors

Natural History, Complications and Prognosis

  • The majority of patients with krukenberg tumor remain asymptomatic or have non-specific gastrointestinal symptoms.[1]
  • Early clinical features include abdominal pain and distension(from the large, bilateral ovarian masses).[1]
  • If left untreated, patients with krukenberg tumors may progress to develop virilization from the excessive hormone production from the ovarian stroma.[6]
  • Common complications of krukenberg tumors include ascites, virilization, and pseudo-Meig syndrome.[6][1]
  • Prognosis is generally poor, and the 5 ­year survival rate of patients with krukenberg tumor is lower in patients in with a preoperative serum CA 125 levels greater than 75 U/mL when compared with patients with CA 125 levels less than 75 U/mL.[7] The median survival of patients is between 7 to 14 months.[6]

Diagnosis

Symptoms

  • Krukenberg's tumor is usually asymptomatic.[1]
  • Symptoms of krukenberg tumors may include the following:[1][2]

Physical Examination

  • Patients with krukenberg tumor usually appear well in the early stages.
  • Physical examination may be remarkable for:[2][1]

Laboratory Findings

  • There are no specific laboratory findings associated with krukenberg tumors.

Imaging Findings

X Ray

  • On x rays, krukenberg tumor may present with the following findings:[4]
  • X ray showing prominent small bowel loops filled with gas, no air-fluid level, no radiographic signs of intestinal obstruction[8]
    X ray showing prominent small bowel loops filled with gas, no air-fluid level, no radiographic signs of intestinal obstruction[8]

Ultrasound

  • On pelvic ultrasound, krukenberg tumor is characterized by the following:[3]</ref>[4]
    • Bilateral, solid ovarian masses with clear, well defined margins
    • An irregular hyper-echoic solid pattern and moth eaten like cyst formation is also considered a characteristic feature
  • Large, solid, well defined bilateral ovarian masses[8]
    Large, solid, well defined bilateral ovarian masses[8]
  • Large, solid, well defined bilateral ovarian masses[8]
    Large, solid, well defined bilateral ovarian masses[8]
  • Large, solid, well defined bilateral ovarian masses[8]
    Large, solid, well defined bilateral ovarian masses[8]
  • Large, solid, well defined bilateral ovarian masses[8]
    Large, solid, well defined bilateral ovarian masses[8]

CT

  • Krukenberg tumour of the right ovary from colon cancer[8]
    Krukenberg tumour of the right ovary from colon cancer[8]

MRI

  • On pelvic MRI, krukenberg tumor is characterized by the following:[10][11][12][4]
    • Bilateral complex masses with hypo-intense solid components (dense stromal reaction)
    • Internal hyperintensity (mucin) on T1 and T2 weighted MR images
    • Strong contrast enhancement is usually seen in the solid component or the wall of the intratumoral cyst
  • Coronal T2 image[8]
    Coronal T2 image[8]
  • Axial T1 image[8]
    Axial T1 image[8]
  • Sagittal T2 image[8]
    Sagittal T2 image[8]
  • Axial T2 image[8]
    Axial T2 image[8]
  • Axial T1 C+ fat sat dynamic contrast study image[8]
    Axial T1 C+ fat sat dynamic contrast study image[8]

Other Diagnostic Studies

Immunohistochemistry

Serum CA-125

  • Serum concentrations of CA 125 may be helpful for:[1]

Treatment

Medical Therapy

  • Management of krukenberg tumors is driven by the identification and treatment of the primary cancer.
  • Chemotherapy/radiation has no significant effect on the prognosis of patients with Krukenberg tumors.[1]

Surgery

  • Bilateral oophorectomy may only be performed for patients where the metastasis is localized to the ovaries.[13]
  • The significance of early detection of ovarian metastasis and the importance of monitoring serum CA 125 level may improve the prognosis.
  • Surgical resection may not be an option if the tumor has already metastasized to other sites.

Prevention

  • There are no preventive measures available for krukenberg tumors.

Case Studies

Case #1

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 Al-Agha OM, Nicastri AD (2006). "An in-depth look at Krukenberg tumor: an overview". Arch Pathol Lab Med. 130 (11): 1725–30. doi:10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2. PMID 17076540.
  2. ↑ 2.0 2.1 2.2 2.3 Krukenberg tumor. Wikipedia. https://en.wikipedia.org/wiki/Krukenberg_tumor#cite_note-Young2006-4 Accessed on March 21, 2016.
  3. ↑ 3.0 3.1 Tellier F, Steibel J, Chabrier R, Blé FX, Tubaldo H, Rasata R; et al. (2012). "Sentinel lymph nodes fluorescence detection and imaging using Patent Blue V bound to human serum albumin". Biomed Opt Express. 3 (9): 2306–16. doi:10.1364/BOE.3.002306. PMC 3447570. PMID 23024922.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Krukenberg tumour. Radiopedia. Accessed on March 23, 2016.
  5. ↑ Ovarian cancer. Wikipedia. https://en.wikipedia.org/wiki/Ovarian_cancer#Genetics Accessed on March 23, 2016.
  6. ↑ 6.0 6.1 6.2 Hornung M, Vogel P, Schubert T, Schlitt HJ, Bolder U (2008). "A case of virilization induced by a Krukenberg tumor from gastric cancer". World J Surg Oncol. 6: 19. doi:10.1186/1477-7819-6-19. PMC 2275731. PMID 18279511.
  7. ↑ Khan M, Bhatti RP, Mukherjee S, Ali AM, Gilman AD, Mirrakhimov AE; et al. (2015). "A 26-year-old female with metastatic primary gastrointestinal malignancy presenting as menorrhagia". J Gastrointest Oncol. 6 (2): E21–5. doi:10.3978/j.issn.2078-6891.2014.080. PMC 4311099. PMID 25830046.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 Image courtesy of Dr Hani Al Salam. Radiopaedia (original file ‘’here’’). Creative Commons BY-SA-NC
  9. ↑ Cho KC, Gold BM (1985). "Computed tomography of Krukenberg tumors". AJR Am J Roentgenol. 145 (2): 285–8. doi:10.2214/ajr.145.2.285. PMID 2992252.
  10. ↑ Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST (2002). "CT and MR imaging of ovarian tumors with emphasis on differential diagnosis". Radiographics. 22 (6): 1305–25. doi:10.1148/rg.226025033. PMID 12432104.
  11. ↑ Ha HK, Baek SY, Kim SH, Kim HH, Chung EC, Yeon KM (1995). "Krukenberg's tumor of the ovary: MR imaging features". AJR Am J Roentgenol. 164 (6): 1435–9. doi:10.2214/ajr.164.6.7754887. PMID 7754887.
  12. ↑ Imaoka I, Wada A, Kaji Y, Hayashi T, Hayashi M, Matsuo M; et al. (2006). "Developing an MR imaging strategy for diagnosis of ovarian masses". Radiographics. 26 (5): 1431–48. doi:10.1148/rg.265045206. PMID 16973774.
  13. ↑ Kim WY, Kim TJ, Kim SE, Lee JW, Lee JH, Kim BG; et al. (2010). "The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries". Eur J Obstet Gynecol Reprod Biol. 149 (1): 97–101. doi:10.1016/j.ejogrb.2009.11.011. PMID 20018420.
Retrieved from "https://www.wikidoc.org/index.php?title=Krukenberg_tumor&oldid=1228010"