Krukenberg Metastasis

Fig. 1: Axial CT image shows circumferential thickening of the gastric antrum.
Fig. 2: Axial CT image of the pelvis shows bilateral, predominantly solid, less than 10 cm, ovarian masses (stars). There is small ascites.

Facts: Krukenberg Metastasis

• Originally described by Dr. Krukenberg in reference to a rare form of malignant ovarian signet-ring tumor that distinction between primary and metastatic signet-ring tumors from the stomach was difficult
• Differentiation between Krukenberg metastatic signet-ring ovarian tumors vs. primary has implication for management and prognosis. Primary signet-ring ovarian tumors can be treated with resection if found early. Krukenberg tumors are indicative of late-stage disease
• Primarily from gastrointestinal adenocarcinoma (stomach, colon)

Imaging Findings

• Distinction between primary and metastatic ovarian tumors can be difficult on imaging. There is no reliable, consistent feature that is accurate enough to differentiate the two
• Radiologist may suggest possible Krukenberg metastasis if ovarian lesions are solid, less than 10 cm, involve both ovaries and present late.

Our case: Signet-ring adenocarcinoma of the stomach with bilateral ovarian metastases (Krukenberg metastasis)

References

1. Brown DL, Zou KH, Tempany CMC, et al. Primary versus secondary ovarian malignancy: imaging findings of adnexal masses in the radiology diagnostic oncology group study. Radiology 2001;219:213-218.

2. Zagoria RJ, Mayo-Smith WW, Fielding JR. Genitourinary imaging case review series, 2nd edition, 2008.