Krukenberg tumour

Krukenberg tumour, also known as carcinoma mucocellulare, refers to the "signet ring" subtype of metastatic tumour to the ovary. The colon and stomach are the most common primary tumours to result in ovarian metastases, followed by the breast, lung, and contralateral ovary.

The tumours represent 5-10% of all ovarian tumours and up to 50% of all metastatic tumours to the ovary. The estimated incidence of Krukenberg tumour is at approximately 0.16/100000 per year 7. They tend to develop during the reproductive years 4-5.

Abdominal or pelvic pain, abdominal bloating, or pain during intercourse, may be the presenting symptom. Irregular bleeding may also be seen. 

Median patient age at presentation is 48 years.

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:

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.

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.

Medial survival

Median overall survival (OS) is of the order of 16 months (CI 15-19) cit. Breakdown by primary:

  • gastric: 11 months
  • colorectal: 21.5 months
  • breast: 31 months
  • other (appendix, gallbladder, small intestine, unknown): 19.5 months

Associated factors for poor prognosis and predictors of unfavourable outcome cit:

  • univariate analysis
    • synchronous metastasis
    • no chemotherapy
    • ovarian metastasis beyond the pelvis
  • multivariate analysis
    • synchronous metastasis (p=0.0080)
    • pelvic invasion (p=0.0138)
    • ascites (p <0.0001)
    • no metastasectomy (p=0.0060)

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

Share article

Article information

rID: 7830
System: Gynaecology
Section: Pathology
Synonyms or Alternate Spellings:
  • Krukenburg Tumour
  • Krukenburg's tumour
  • Kruckenberg tumour
  • Krukenberg tumours
  • Krukenberg tumor
  • Krukenberg tumour
  • Carcinoma mucocellulare
  • Krukenberg tumors

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Krukenberg tumour...
    Figure 1: macroscopic pathology specimen
    Drag here to reorder.
  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    Pelvic CT

A mild...
    Case 2
    Drag here to reorder.
  • Drag
    Case 3
    Drag here to reorder.
  • Drag
    T2 axial
    Case 4
    Drag here to reorder.
  • Drag
    Large, solid, wel...
    Case 5
    Drag here to reorder.
  • Drag
    Case 6
    Drag here to reorder.
  • Drag
    Case 7
    Drag here to reorder.
  • Drag
    Case 8
    Drag here to reorder.
  • Drag
    Case 9
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.