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Krukenberg tumour

Dr Saeed Soltany Hosn and Dr Yuranga Weerakkody et al.

A Krukenberg tumour (also referred to as a carcinoma mucocellulare) refers to a type of metastatic tumour to the ovary.The colon and stomach are the most common primary tumour to result in ovarian metastases, followed by the breast, lung, and contralateral ovary. 

Epidemiology

The tumours represent 5 - 10% of all ovarian tumours and upto 50% of all metastatic tumours to the ovary. The estimated incidence of Krukenberg tumour is at approximately 0.16/100.000 per year 7.

They tend to develop during the reproductive years 4-5. 

Clinical presentation

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Pathology and pathophysiology

Krukenberg tumours are metastatic tumours to the ovary that contain well defined histological characteristics - mucin-secreting “signet ring” cells and usually originate in the gastrointestinal tract 4. 

The time from diagnosis of the primary neoplasm to the development of ovarian metastasis is variable, and can range from several months to > 10 years.

Cytologic examination often reveals mucoid degeneration and many large cells shaped like signet rings.

They can originate from: 1

Radiographic features

Most imaging features are non-specific, consisting of predominantly solid components or a mixture of cystic and solid areas. It is often difficult to differentiate from other ovarian neoplasms 4-5.  There are a variety of metastatic carcinomas to the ovary that can mimic primary ovarian tumours 4.

Pelvic ultrasound

These tumour are typically seen sonographically as bilateral, solid ovarian masses, with clear well defined margins. An irregular hyper-echoic solid pattern and moth eaten like cyst formation is also considered a characteristic feature 7.

CT

CT appearances can be indistinguishable from primary ovarian carcinoma 2. Features will favour towards a Krukenberg tumour if a concurrent gastric or colic mural lesion is seen. There is some evidence that tumours originating from the stomach may be denser on contrast enhanced CT than those originating from the colon 3.

Pelvic MRI

The great majority of Krukenberg tumours are signet-ring cell carcinomas arising in the stomach. Signet-ring cells scatter in the ovarian stroma with abundant collagen formation or marked oedema. Therefore, Krukenberg tumours can occasionally show low or high signal intensity on T2-weighted images 6.

Krukenberg tumours may demonstrate some distinctive findings on MRI, including: 

  • bilateral complex masses with hypo-intense solid components (dense stromal reaction) 4-5
  • internal hyperintensity (mucin) on T1 and T2 weighted MR images 4

Strong contrast enhancement is usually seen in the solid component or the wall of the intratumoural cyst 6.

Treatment and prognosis

Differentiation between primary and metastatic ovarian carcinoma is of great importance with respect to treatment and prognosis, but may be very difficult based upon imaging findings solely. 

Etymology

It is named after Friedrich E. Krukenberg : German pathologist (1871 - 1946) who first described them in 1896.

See also

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