Resident Program - Case of the Month

June 2023 – Presented by Dr. Larry Ha (Mentored by Dr. Kurt Schaberg)

Discussion

The ovary is a common site of metastases. Approximately 7% of lesions presenting clinically as primary ovarian tumors are of metastatic origin. Krukenberg tumors refer to ovarian neoplasm usually from a primary carcinoma, classically from the gastrointestinal tract, but can also arise from other tissues such as breast. Gastric and colorectal cancers account for 90% of the primary site for this tumor. The average age of diagnosis is 35 to 45 years. Incidence of this tumor is higher in Asian countries and believed to be attributed to the higher prevalence of gastric cancers. The mechanism of the tumor spread is still unclear.

Grossly, the ovaries are asymmetrically enlarged with a gelatinous cut surface. The capsular surface is usually free of tumor infiltrates, adhesions, and implants. The characteristic histologic finding is the presence of mucin-laden signet-ring cells, which are present in >10% of cases. The signet rings have eccentric hyperchromatic nuclei. About a third of patients will have either a positive CK7 or CK20. About a quarter of patients may have increased CEA or CA125. For a gastric primary, tumor will be positive for CK7, CK20, and CDX2 but negative for SATB2. For a colorectal primary, tumor will be positive for CD20, CDX2 and SATB2 but negative for CK7.

For this case, the primary site in the stomach was identified after the diagnosis of Krukenberg tumor.  Carcinoma metastatic to the ovary is associated with poor prognosis.

References

1. Aziz, M. (2023, February 21). "Krukenberg Tumor". In StatPearls. StatPearls Publishing. Retrieved May 18, 2022
2. Gilks, B. (2018). "Chapter 35: Ovary". In Rosai and Ackerman’s Surgical Pathology. 11^th edition (pp 1413-1417). Philadelphia, Pennsylvania: Elsevier.
3. McCluggage WG: "Immunohistochemistry in the distinction between primary and metastatic ovarian mucinous neoplasms". J Clin Pathol. 65(7):596-600, 2012.