Abstract
Tumors that commonly metastasize to the bone are carcinomas arising in the prostate, breast, lung and neuroblastoma. Rarely epithelial tumours of the ovary metastasize to the bone and bone marrow. There are only few case reports in the literature describing bone and bone marrow metastasis from primary as well as secondary Krukenberg tumours of the ovary. We present a case of an adenocarcinoma of stomach and bilateral metachronous ovarian Krukenberg tumour (secondary) who was referred to our department with complaints of generalised bone pains. Technetium 99m (Tc 99m) MDP whole body bone scan was done which revealed metastasis throughout skeletal system (super scan). JMS 2014;17(2):64-68
Highlights
Krukenberg tumors are mucin secreting, signet ring cell tumours that arise either from the ovary itself or from other organs like gastrointestinal tract, breast, cervix urinary bladderetc.[1,2] Krukenberg tumour was originally described by Paget in 1854 and the name was attributed to Dr Friedrich Krukenberg and account for 1% of all the ovarian neoplasms worldwide.[2,3] Gastric cancer is the most common primary site[1 2 3] followed by breast, colon and appendix.[2,3] A history of primary carcinoma in stomach or elsewhere is present in only 20 to 30 % of the patients
Though the entity of primary Krukenberg tumour cannot be denied, all patients of typical Krukenberg tumour should be considered as having metastatic carcinoma usually from stomach[5]
We present a rare case of metachronous bilateral ovarian Krukenberg tumour with diffuse skeletal metastasis on a bone scan
Summary
Krukenberg tumors are mucin secreting, signet ring cell tumours that arise either from the ovary itself or from other organs like gastrointestinal tract, breast, cervix urinary bladderetc.[1,2] Krukenberg tumour was originally described by Paget in 1854 and the name was attributed to Dr Friedrich Krukenberg and account for 1% of all the ovarian neoplasms worldwide.[2,3] Gastric cancer is the most common primary site[1 2 3] followed by breast, colon and appendix.[2,3] A history of primary carcinoma in stomach or elsewhere is present in only 20 to 30 % of the patients. A 38 year old female patient of bilateral krukenberg tumor was referred to the Department of Nuclear Medicine for a radionuclide Tc 99m MDP whole body bone scan. Patient presented with chief complaints of generalised body pains for the last 4 months Patient had underwent radical subtotal gastrectomy two years before for adenocarcinoma of stomach followed by chemo-radiotherapy. A follow up contrast enhanced CT abdomen and USG abdomen- pelvis done four months later revealed retroperitoneal lyphadenopathy with right lobe liver metastasis .The patient was treated with external beam radiotherapy through anterior and posterior para aortic fields for the same. Patient was referred to the department of Nuclear Medicine for a whole body scan on complaints of generalised body pains. Bone scan revealed multiple foci of increased tracer uptake seen in skull, sternum, bilateral ribs, thoracic spine, lower lumbar spine, pelvis, bilateral femoral shaft with poor soft tissue uptake and faintly visualised kidneys consistent with diffuse skeletal metastasis (super Scan) Figure 1
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