Presentation
Chronic cough and worsening shortness of breath. Expanding abdominopelvic mass over the last 2 months.
Patient Data
Huge abdominal mass clearly visible on examination.
Blood results
- hypochromic microcytic anemia
- CEA: 126 (normal 0-5)
- CA 125: 51 (normal 0-35)
Multiple focal nodular densities throughout both lungs. In the context of suspected malignancy, these are highly suspicious for metastatic disease.
Large hypoechoic heterogeneous multi-lobulated mass within the abdomen. Not hypervascular.
CT confirmed the US finding of a large lobulated intra-abdominal mass and confirmed liver and lung metastases.
Surgery 1 month later:
- clinical deterioration with pain
- worsening anemia
- decompensation of respiratory function
Intraoperative photography demonstrating a large tumor arising from the ovary and a much smaller primary colonic neoplasm.
The large ovarian mass has the expected lobulated pattern. The thickened cecal wall seen on the CT is identified intra-operatively.
Case Discussion
Krukenberg tumor (carcinoma mucocellulare)
- metastatic ovarian adenocarcinoma from different primary tumor sites
- gastric carcinoma is the commonest primary tumor (~50% of Krukenberg tumors)
- T4 colonic adenocarcinoma have potential for transcoelomic spread to the ovaries
- discrimination between primary and metastatic ovarian tumors is important
Learning points
- if an ovarian "primary" tumor is reported as mucinous or adenocarcinoma: think could this be a Krukenberg tumor until proven otherwise
- iron deficiency anemia in post-menopausal women: think - right-sided colon cancer