Krukenberg's tumor as the first clinical manifestation of cancer: A single institutional review of cases from 1993-2008 from South India.

Abstract

e15541 Background: To analyze clinical data such as, presentation, diagnosis, treatment and follow up of patients presenting with Krukenberg's tumor as the first clinical manifestation of cancer to a single institution in South India. Methods: We retrospectively analyzed medical data from 41 patients who were referred to the Medical Oncology Department of the Institute of Obstetrics and Gynecology, Madras Medical College, Chennai between 1993 and 2008. Results: The patients ranged from 24 to 70 years (median, 45.5 years) with 41% of them being pre-menopausal. Abdominal distension or pain accounted for the commonest clinical presentation. Ascites was present in 49% of patients. 58% of the tumors were documented to be bilateral. Before a definitive diagnosis of ovarian tumor, investigations such as ultrasonography and chest X-Ray were undertaken in all patients. Computed tomography and CA-125 results were available for 13 patients. The highest level of CA-125 was 134 IU/mL. 27(66%) patients underwent surgery. The most common surgery performed was a debulking surgery. Microscopy suggested a digestive tract malignancy in 31 patients, ductal carcinoma in 5 patients, and mucinous adenocarcinoma in 5 patients. The details of the work-up for the primary site of cancer was available for all patients. Primary site of malignancy was stomach in 20 (48.4%) patients, colonic cancer in 7 (17%) patients, pancreatic cancer in 1 (2.4%) patient, breast cancer in 5 (12.2%) patients, lung cancer in 1 (2.4%) patient, and unknown primary site in 7 (17%) patients. 29 patients received Palliative chemotherapy. Follow-up data was available for 29 patients. The median overall survival was 7 months in our group of patients. Conclusions: There is poor prognosis for patients presenting with Krukenberg's tumor as the initial clinical manifestation of cancer. Bilateral ovarian tumor with ascites especially in premenopausal women should arouse suspicion. Diagnosis is late and most patients undergo surgery for ovarian tumor. The most common primary tumor is gastrointestinal tract cancer. No significant financial relationships to disclose.