Krukenberg Tumors: A Review

Abstract

A Krukenberg tumor is a rare tumor of the ovary derived from metastatic gastrointestinal tissue. Although the eponym is attributed to Dr. Friedrich Krukenberg, a German gynecologist and pathologist, the Krukenberg tumor was actually described by both Paget (1854) and Wilks (1859). Worldwide, they account for about 1% of all ovarian neoplasms. Gastric cancer is the most frequent primary source, followed by breast, colon and appendix. For those carcinomas originating from the intestinal tract, about 80% are found within either the sigmoid colon or rectum. Presenting symptoms include nonspecific abdominal pain, distention, ascites, virilization, hirsutism and menometrorrhagia. This paper presents the hospital course and operative intervention on a 48-year-old female with bilateral ovarian Krukenberg tumors metastasized from an adenocarcinoma of the sigmoid colon. Citation: Ben-Jacob TK, Gordon CR, Koniges F (2015) Prog Science 2(2):e12 | doi: 10.14721/pscience.2015.e12 Original Published: J Surg Radiol. 2010 Jul 1;1(1) | Republished: 02/20/2015 Copyright: © 2015 Ben-Jacob TK. et al. Published by TranScience. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. Funding: none Competing Interests: The authors have declared that no competing interests exist. E-mail: ben-jacob-talia@cooperhealth.edu elevated at 13 and 882, respectively, and her hemoglobin was low at 10.9. Her electrolytes were all within normal limits and her urinalysis was positive for a urinary tract infection. An obstruction series was performed that revealed a laterally-displaced, dilated loop of colon in the left lower quadrant (Figure 1). The patient was admitted to the general medicine service, with consults placed to the gastroenterology, general surgery, and gynecology-oncology services. A computed tomography (CT) scan of her abdomen/pelvis demonstrated a large pelvic mass of unknown etiology (Figure 2). The mass was displacing her small bowel in the cephalad direction and partially obstructing her left ureter, with bi-lobar liver lesions suspicious for metastasis. A colonoscopy revealed a nearobstructing colon lesion reported to be at 60 cm from the anal verge. Biopsies were obtained and consistent with colonic adenocarcinoma. She underwent an exploratory laparotomy, with plans for a diverting ileostomy or colostomy and mass biopsy. Exploratory laparotomy revealed two large, complex ovarian masses. The right ovary was easily mobilized and resected. The ovary measured 25 x 23 x 8 cm and weighed 2,500 grams (Figure 3). The left ovary was also massive, but unlike the other, was adherent to the patient’s sigmoid colon and pelvic sidewall. After careful dissection,