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Krukenberg
tumor
A Krukenberg
tumor
classically
refers to a
secondary
ovarian
malignancy
whose
primary site
arose in the
gastrointestinal
tract.
Krukenberg
tumors are
often found
in both
ovaries.
Microscopically,
they are
characterized
by
appearance
of mucin-secreting
signet-ring
cells in the
tissue of
the ovary;
when the
primary
tumor is
discovered,
the same
signet-ring
cells will
be found.
Historical
The
Krukenberg
tumor is
named after
Friedrich
Ernst
Krukenberg
(1871-1946),
a German
doctor who
first
described
them as "fibrosarcoma
ovarii
mucocellulare
carcinomatodes".
A short
biography of
Krukenberg
can be found
at
WhoNamedIt.com
Etiology and
Incidence
Metastatic
cancer of
the ovary
accounts for
only about
5% of
ovarian
cancer; in
the
remainder,
the ovary is
the primary
cancer site.
Krukenberg
tumors are
the third
most common
metastatic
ovarian
cancer
(after
epithelial
and
germ-cell
tumors) and
make up 14%
of these
cancers.
Unlike some
forms of
cancer,
there is no
racial bias.
Krukenberg
tumors are
most
commonly
seen in
middle-aged
and elderly
females,
around or
following
the
menopause.
Symptoms
Patients
with
Krukenberg
tumor often
come to the
attention of
their doctor
when they
present
complaining
of abdominal
or pelvic
pain,
bloatedness,
vaginal
bleeding, a
change in
their
menstrual
habit or
pain during
intercourse.
These
symptoms are
non-specific
(i.e. they
point to a
range of
problems
other than
cancer) and
a diagnosis
can only be
made
following
Computed
Tomography
(CT) scans,
laparotomy
and/or a
biopsy of
the ovary.
Pathogenesis
There is
some debate
over the
exact
mechanism of
metastasis
of the
tumour cells
from the
stomach,
appendix or
colon to the
ovaries;
classically
it was
thought that
direct
seeding
across the
abdominal
cavity
accounted
for the
spread of
this tumor,
but recently
some
researchers
have
suggested
that
lymphatic
(i.e.
through the
lymph
nodes), or
haematogenous
(i.e.
through the
blood)
spread is
more likely,
as most of
these
tumours are
found on the
inside of
the ovaries.
Proponents
of this
theory cite
the fact
that
metastases
are never
found in the
omentum (the
fatty apron
which
envelops the
organs of
the abdomen
and lies
between the
stomach and
ovaries),
and that the
tumor cells
are found
within the
ovary and
not growing
inwards.
However,
this remains
a
controversy,
as cases in
Hong Kong
always
showed
omental
spread and
peritoneal
seedlings in
patients
with
Krukenberg
tumours.
Although a
Krukenberg
tumor is
most
commonly a
metastasis
from a
gastric
cancer
(usually an
adenocarcinoma),
this is not
always the
case. Other
tumours of
the
gastrointestinal
tract
(including,
significantly,
colon
cancer) have
been known
to cause
Krukenberg
tumours, and
recent
case-reports
of
Krukenberg
tumors
originating
from tumors
of the tip
of the
appendix
have
appeared in
the medical
literature.
Treatment
and
Prognosis
Since the
Krukenberg
tumor is a
secondary (metastatic)
tumor,
management
of the tumor
must involve
finding and
treating the
primary
cancer. In
general,
most cases
of
Krukenberg
tumor have a
poor
prognosis
and radical
operation
such as
removal of
the ovaries
(and the
colon or
appendix if
involved)
can improve
survival
only in
cases of
solitary
ovarian
metastasis
or local
extended
disease
(i.e. the
lesion is
located only
in the
pelvis).
Cancer
chemotherapy
and
radiotherapy
before
surgery may
be used to
shrink the
tumor and
facilitate
its removal.
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