Krukenberg tumour
Updates to Article Attributes
Krukenberg tumour,also known as carcinoma mucocellulare, refers to the "signet ring" subtype of metastatic tumour to the ovary. The stomach followed by colon and stomach are the two most common primary tumours to result in ovarian metastases, followedpursued by the breast, lung, and contralateral ovary.
Epidemiology
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. They tend to develop during the reproductive years 4-5.
Clinical presentation
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 4845 years9.
Pathology
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:
- stomach cancer (signet-ring cells): most common
- colorectal carcinoma: second most common
- breast cancer
- lung cancer
- contralateral ovarian carcinoma
- pancreatic carcinoma
-
cholangiocarcionomacholangiocarcinoma/gallbladder carcinoma
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 tumours are typically seen sonographically as:
- bilateral, solid and some times cystic ovarian masses, with clear well-defined margins.
An - an irregular hyper-echoic solid pattern and moth-eaten like cyst formation is also considered a characteristic feature.
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 intratumoral 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.
Median survival
MedianIt is a stage IV disease, median overall survival is of the order of approximately 16 months 8,9. The breakdown by primary tumour location is as follows 8:
- 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 include 8,9:
- univariate analysis
- synchronous metastasis
- no chemotherapy
- ovarian metastasis beyond the pelvis
- multivariate analysis
- synchronous metastasis
- pelvic invasion
- ascites
- no metastasectomy
History and etymology
It is named after Friedrich E. Krukenberg, German pathologist (1871-1946) who first described them in 1896.
See also
-<p><strong>Krukenberg tumour</strong>,<strong> </strong>also known as <strong>carcinoma mucocellulare</strong>, refers to the "signet ring" subtype of metastatic tumour to the <a href="/articles/ovary">ovary</a>. The colon and stomach are the most common primary tumours to result in <a href="/articles/metastases-to-the-ovary">ovarian metastases</a>, followed by the breast, lung, and contralateral ovary.</p><h4>Epidemiology</h4><p>The tumours represent 5-10% of all <a href="/articles/ovarian-tumours">ovarian tumours</a> 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. They tend to develop during the reproductive years <sup>4-5</sup>.</p><h4>Clinical presentation</h4><p>Abdominal or pelvic pain, abdominal bloating, or pain during intercourse, may be the presenting symptom. Irregular bleeding may also be seen. </p><p>Median patient age at presentation is 48 years.</p><h4>Pathology</h4><p>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 <sup>4</sup>.</p><p>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.</p><p>Cytologic examination often reveals mucoid degeneration and many large cells shaped like signet rings.</p><p>They can originate from <sup>1</sup>:</p><ul>- +<p><strong>Krukenberg tumour</strong>,<strong> </strong>also known as <strong>carcinoma mucocellulare</strong>, refers to the "signet ring" subtype of metastatic tumour to the <a href="/articles/ovary">ovary</a>. The stomach followed by colon are the two most common primary tumours to result in <a href="/articles/metastases-to-the-ovary">ovarian metastases</a>, pursued by the breast, lung, and contralateral ovary.</p><h4>Epidemiology</h4><p>The tumours represent 5-10% of all <a href="/articles/ovarian-tumours">ovarian tumours</a> 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. They tend to develop during the reproductive years <sup>4-5</sup>.</p><h4>Clinical presentation</h4><p>Abdominal or pelvic pain, abdominal bloating, or pain during intercourse, may be the presenting symptom. Irregular bleeding may also be seen. </p><p>Median patient age at presentation is 45 years <sup>9</sup>.</p><h4>Pathology</h4><p>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 <sup>4</sup>.</p><p>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.</p><p>Cytologic examination often reveals mucoid degeneration and many large cells shaped like signet rings.</p><p>They can originate from <sup>1</sup>:</p><ul>
-<a href="/articles/colorectal-carcinoma">colorectal carcinoma</a>: second most common</li>- +<a href="/articles/colorectal-cancer-1">colorectal carcinoma</a>: second most common</li>
-<a href="/articles/cholangiocarcinoma">cholangiocarcionoma</a>/<a href="/articles/gallbladder-carcinoma">gallbladder carcinoma</a>- +<a href="/articles/cholangiocarcinoma">cholangiocarcinoma</a>/<a href="/articles/gallbladder-carcinoma">gallbladder carcinoma</a>
-</ul><h4>Radiographic features</h4><p>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 <sup>4-5</sup>. There are a variety of metastatic carcinomas to the ovary that can mimic primary ovarian tumours <sup>4</sup>.</p><h5>Pelvic ultrasound</h5><p>These tumours 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.</p><h5>CT</h5><p>CT appearances can be indistinguishable from <a href="/articles/ovarian-tumours">primary ovarian carcinoma</a> <sup>2</sup>. 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 <sup>3</sup>.</p><h5>Pelvic MRI</h5><p>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 <sup>6</sup>.</p><p>Krukenberg tumours may demonstrate some distinctive findings on MRI, including:</p><ul>- +</ul><h4>Radiographic features</h4><p>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 <sup>4-5</sup>. There are a variety of metastatic carcinomas to the ovary that can mimic primary ovarian tumours <sup>4</sup>.</p><h5>Pelvic ultrasound</h5><p>These tumours are typically seen sonographically as:</p><ul>
- +<li>bilateral, solid and some times cystic ovarian masses, with clear well-defined margins.</li>
- +<li>an irregular hyper-echoic solid pattern and moth-eaten like cyst formation is also considered a characteristic feature.</li>
- +</ul><h5>CT</h5><p>CT appearances can be indistinguishable from <a href="/articles/ovarian-tumours">primary ovarian carcinoma</a> <sup>2</sup>. 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 <sup>3</sup>.</p><h5>Pelvic MRI</h5><p>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 <sup>6</sup>.</p><p>Krukenberg tumours may demonstrate some distinctive findings on MRI, including:</p><ul>
-</ul><p>Strong contrast enhancement is usually seen in the solid component or the wall of the intratumoral cyst <sup>6</sup>.</p><h4>Treatment and prognosis</h4><p>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.</p><h5>Median survival</h5><p>Median overall survival is of the order of approximately 16 months <sup>8</sup>. The breakdown by primary tumour location is as follows <sup>8</sup>:</p><ul>- +</ul><p>Strong contrast enhancement is usually seen in the solid component or the wall of the intratumoral cyst <sup>6</sup>.</p><h4>Treatment and prognosis</h4><p>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.</p><h5>Median survival</h5><p>It is a stage IV disease, median overall survival is of the order of approximately 16 months <sup>8,9</sup>. The breakdown by primary tumour location is as follows <sup>8</sup>:</p><ul>
-</ul><p>Associated factors for poor prognosis and predictors of unfavourable outcome include <sup>8</sup>:</p><ul>- +</ul><p>Associated factors for poor prognosis and predictors of unfavourable outcome include <sup>8,9</sup>:</p><ul>
-</ul><h4>History and etymology</h4><p>It is named after <strong>Friedrich E. Krukenberg</strong>, German pathologist (1871-1946) who first described them in 1896.</p><h4>See also</h4><ul><li><a href="/articles/ovarian-tumours">ovarian tumours</a></li></ul>- +</ul><h4>History and etymology</h4><p>It is named after <strong>Friedrich E. Krukenberg</strong>, German pathologist (1871-1946) who first described them in 1896.</p><h4>See also</h4><ul>
- +<li><a href="/articles/ovarian-tumours">ovarian tumours</a></li>
- +<li><a href="/articles/gastric-adenocarcinoma">stomach cancer</a></li>
- +</ul>
References changed:
- 8. Muhammad Aziz, Anup Kasi. Krukenberg Tumor. (2021) <a href="https://www.ncbi.nlm.nih.gov/pubmed/29489206">Pubmed</a> <span class="ref_v4"></span>
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