J Korean Soc Radiol.  2015 Jun;72(6):435-438. 10.3348/jksr.2015.72.6.435.

Krukenberg Tumors Diagnosed during Pregnancy Simultaneously with Advanced Gastric Cancer: A Case Report

• You MW
• Jung YY
• Shin JH
• Hong YO

• KMID: 2098026
• DOI: http://doi.org/10.3348/jksr.2015.72.6.435

Abstract

Krukenberg tumors recognized during pregnancy are rarely reported. The preoperative diagnosis can be challenging because of the confusing morphological features and symptoms during pregnancy. Here, we report a case of a 29-year-old pregnant woman at 29 weeks gestation presenting with bilateral solid ovarian masses, which were later diagnosed as metastatic ovarian cancer originating from advanced gastric cancer. This case suggests that Krukenberg tumors should be considered when bilateral ovarian solid masses are encountered regardless of pregnancy.

MeSH Terms

Adult
Diagnosis
Female
Humans
Krukenberg Tumor*
Magnetic Resonance Imaging
Ovarian Neoplasms
Pregnancy*
Pregnant Women
Stomach Neoplasms*
Ultrasonography

Figure

• 

  Fig. 1 29-year-old woman in a 29-week gestation with bilateral Krukenberg tumors and advanced gastric cancer. A. T2-weighted half-Fourier acquisition single shot turbo spin echo axial image shows iso to high signal intensity (SI) solid masses in bilateral ovaries with lower SI follicle-like nodules in periphery of the mass (black arrows). Large amount of ascites is present. She is in third trimester pregnancy and fetus in the uterus is seen in this image. B. Diffusion-weighted axial image (b-value = 800) shows diffusion restriction in bilateral ovarian masses (black arrows). C. Irregular gastric wall thickening along the gastric body and antrum has been detected retrospectively (black arrows). Omental fluffy soft tissues are also noted (dashed arrow), which is confirmed to be advanced gastric cancer and peritoneal carcinomatosis along with large amount of ascites. D. Ultrasonography reveals heterogeneously echogenic solid masses in bilateral ovaries (8.6 cm mass in left ovary, right ovary mass is not shown here), raise the suspicion of malignancy. E. Color Doppler image shows peripheral vascularity leading to right ovarian mass, which is thought to be leading vessel (white arrow). F. Gross specimen reveals pinkish tan to fleshy appearance with multiple nodularity of the ovarian mass. Hemorrhage and microcysts are also found. G. In microscopic exam (hematoxylin and eosin stain, × 400) of ovarian mass, many signet ring cells with eosinophilic cytoplasm and abundant mucin (white arrows) are interspersed in the ovarian stroma.

Reference

1. Machado F, Vegas C, Leon J, Perez A, Sanchez R, Parrilla JJ, et al. Ovarian cancer during pregnancy: analysis of 15 cases. Gynecol Oncol. 2007; 105:446–450.

2. Schwartz N, Timor-Tritsch IE, Wang E. Adnexal masses in pregnancy. Clin Obstet Gynecol. 2009; 52:570–585.

3. Leiserowitz GS, Xing G, Cress R, Brahmbhatt B, Dalrymple JL, Smith LH. Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol. 2006; 101:315–321.

4. Papantoniou N, Belitsos P, Hatzipapas I, Rodolakis A, Papaspyrou I, Antsaklis A. Excessive hirsutism in pregnancy because of Krukenberg tumor. J Matern Fetal Neonatal Med. 2012; 25:869–871.

5. Grigoriadis C, Eleftheriades M, Panoskaltsis T, Bacanu AM, Vitoratos N, Kondi-Pafiti A, et al. Ovarian cancer diagnosed during pregnancy: clinicopathological characteristics and management. G Chir. 2014; 35:69–72.

6. Testa AC, Licameli A, Di Legge A, Mascilini F, Petruzziello L, Pelagalli M, et al. Color Doppler sonographic features of a Krukenberg tumor in pregnancy. J Ultrasound Med. 2009; 28:695–698.

7. Testa AC, Mancari R, Di Legge A, Mascilini F, Salutari V, Scambia G, et al. The 'lead vessel': a vascular ultrasound feature of metastasis in the ovaries. Ultrasound Obstet Gynecol. 2008; 31:218–221.

8. Cheng CY, Chen TY, Lin CK, Tsao SM, Shih IF, Shy SW. Krukenberg tumor in pregnancy with delivery of a normal baby: a case report. Zhonghua Yi Xue Za Zhi (Taipei). 1994; 54:424–427.

9. Genç M, Genç B, Solak A, Gür E, Sezgin C. Bilateral Krukenberg tumor in a 16-week pregnant woman. Eur J Gynaecol Oncol. 2014; 35:95–96.

10. Singhal SR, Nanda S, Chaudhry P, Sen J, Singhal SK. Metastatic bilateral malignant ovarian tumors associated with pregnancy. Taiwan J Obstet Gynecol. 2009; 48:167–168.