Incidental diagnosis of torsion of a Krukenberg tumor originating from sigmoid colon cancer

Abstract

A Krukenberg tumor refers to gastrointestinal cancer that metastasizes to the ovaries; this tumor was named after Krukenberg, who originally described this pathologic condition of the ovaries in 1896. The prognosis of this tumor is uniformly poor [1]. In the malignant state, the torsion of ovarian tumor is a rare condition because of the adhesions associated with malignant lesions. Two cases of torsion of Krukenberg tumors have been reported so far [2, 3]. A 46-year-old woman presented to the emergency department with abdominal pain. Abdominopelvic computed tomography showed a multicystic lesion with a diameter of 6.6 cm in the right ovary (Fig. 1). Pelviscopy showed a right ovarian mass that had twisted three times in a counterclockwise direction (Fig. 2). Right salpingo-oophorectomy was performed under pelviscopy. Strangely, however, the excised ovarian tissue was friable like caseous necrosis. After the right salpingooophorectomy was completed, the surgical specimen was sent to the department of pathology for obtaining a frozen section. Frozen-section analysis led to the diagnosis of adenocarcinoma; we performed exploratory laparotomy. Moreover, total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy, Fig. 1 The coronal section of abdominopelvic computed tomography showed a right adnexal mass with torsion (arrow)