A Krukenberg tumor refers to a
malignancy in the ovary that
metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast.
Gastric adenocarcinoma, especially at the
pylorus, is the most common source.
Krukenberg tumors are often (over 80%)
found in both ovaries, consistent with its metastatic nature.
Signs and symptoms
Krukenberg tumors often come to the attention when they cause abdominal or pelvic pain, bloating,
ascites, or pain during sexual intercourse. Krukenberg tumors can occasionally provoke a reaction of the ovarian stroma which leads to hormone production, that results in vaginal bleeding, a change in menstrual habits, or
hirsutism,
or occasionally
virilization as a main symptom. In rare cases the disease can manifest with hydronephrosis and hydroureter.
All these symptoms are non-specific and can also arise with a range of problems other than cancer, and a diagnosis can only be made following confirmatory investigations such as
computed tomography (CT) scans,
laparotomy
A laparotomy is a surgical procedure involving a surgical incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy.
Origins and history
The first successful laparotomy was performed without ane ...
and/or a
biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a dise ...
of the ovary.
Cause and incidence
Krukenberg tumors can be seen in all age groups, with an average age of 45 years.
In most countries, cancer that has
metastasized to the ovary accounts for only about 1 to 2% of
ovarian cancer
Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different ...
;
in the remainder, the ovary itself is the primary cancer site. However, in Japan they represent a much higher percentage of malignancies in the ovary (almost 20%) due to the increased prevalence of gastric cancer.
Krukenberg tumors account for about 15% of metastatic cancers that initially appear to have arisen in the ovary, and as such is less common than metastasis arising from ovarian epithelial and germ-cell tumors.
In people who have had nongynecologic malignancy, approximately 20% of
adnexal masses are malignant, and 60% of these are Krukenberg tumors.
Pathogenesis
There has been debate over the exact mechanism of metastasis of the tumor 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 spread by way of the
lymphatic is considered more likely.
Retrograde lymphatics are thought to be more important in the pathogenesis of Krukenberg tumour, since the ovaries in Krukenberg tumour do not show capsular invasion or a breech of the epithelium lining the surface. The average age of diagnosis of Krukenberg tumors may partly relate to the relatively increased vascularity of the ovaries.
Microscopically, Krukenberg tumors are often characterized by
mucin-secreting
signet-ring cells in the tissue of the ovary;
when the primary tumor is discovered, the same signet-ring cells are typically found. However, other microscopic features can predominate.
Krukenberg tumors are most commonly metastases from
gastric cancer
Stomach cancer, also known as gastric cancer, is a cancer that develops from the lining of the stomach. Most cases of stomach cancers are gastric carcinomas, which can be divided into a number of subtypes, including gastric adenocarcinomas. Lym ...
, particularly
adenocarcinoma
Adenocarcinoma (; plural adenocarcinomas or adenocarcinomata ) (AC) is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, o ...
, or
breast cancer
Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or ...
[ particularly invasive lobular breast carcinoma,]cytokeratin 7
Keratin, type II cytoskeletal 7 also known as cytokeratin-7 (CK-7) or keratin-7 (K7) or sarcolectin (SCL) is a protein that in humans is encoded by the ''KRT7'' gene. Keratin 7 is a type II keratin. It is specifically expressed in the simple epith ...
(CK7) may be more likely to be of colorectal origin.
Treatment and prognosis
Since Krukenberg tumors are secondary (metastatic), management might logically be driven by identifying and treating the primary cancer. The optimal treatment of Krukenberg tumors is unclear.chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemother ...
and/or radiotherapy is uncertain
History
Krukenberg tumors are named after Friedrich Ernst Krukenberg (1871–1946),
References
External links
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{{DEFAULTSORT:Krukenberg Tumor
Gastrointestinal cancer
Ovarian cancer