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Ovarian Metastases Including Krukenberg Tumor
Bryan R. Foster, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        TERMINOLOGY

        • Definitions

          • Secondary (metastatic) neoplasms to ovary
          • Krukenberg tumor
            • Subtype of metastatic tumors that contain > 10% mucin-filled signet cells in cellular stroma
            • Usually from gastrointestinal tract, with 76% arising from stomach
            • Krukenberg tumor is sometimes used inappropriately by some to include all metastatic ovarian carcinomas
          • High-stage mucinous tumors involving ovary frequently represent metastases from extraovarian primary sites and are often misdiagnosed as primary ovarian mucinous tumors

        IMAGING

        • General Features

          • Ultrasonographic Findings

            • CT Findings

              • MR Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Jeung YJ et al: Krukenberg tumors of gastric origin versus colorectal origin. Obstet Gynecol Sci. 58(1):32-9, 2015
                                          2. Nakamura Y et al: A Krukenberg Tumor from an Occult Intramucosal Gastric Carcinoma Identified during an Autopsy. Case Rep Oncol Med. 2014:797429, 2014
                                          3. Alvarado-Cabrero I et al: Metastatic ovarian tumors: a clinicopathologic study of 150 cases. Anal Quant Cytol Histol. 35(5):241-8, 2013
                                          4. La Fianza A et al: Intralesional hemorrhage in Krukenberg tumor: a case report and review of the literature. J Ultrasound. 16(2):89-91, 2013
                                          5. Guerriero S et al: Preoperative diagnosis of metastatic ovarian cancer is related to origin of primary tumor. Ultrasound Obstet Gynecol. 39(5):581-6, 2012
                                          6. Ho L et al: Bilateral ovarian metastases from gastric carcinoma on FDG PET/CT. Clin Nucl Med. 37(5):524-7, 2012
                                          7. Willmott F et al: Radiological manifestations of metastasis to the ovary. J Clin Pathol. 65(7):585-90, 2012
                                          8. Kitajima K et al: FDG PET/CT features of ovarian metastasis. Clin Radiol. 66(3):264-8, 2011
                                          9. Maeda-Taniguchi M et al: Metastatic mucinous adenocarcinoma of the ovary is characterized by advanced patient age, small tumor size, and elevated serum CA125. Gynecol Obstet Invest. 72(3):196-202, 2011
                                          10. Soslow RA: Mucinous ovarian carcinoma: slippery business. Cancer. 117(3):451-3, 2011
                                          11. Zaino RJ et al: Advanced stage mucinous adenocarcinoma of the ovary is both rare and highly lethal: a Gynecologic Oncology Group study. Cancer. 117(3):554-62, 2011
                                          12. Abe Y et al: A case of metastatic malignant melanoma of the ovary with a multilocular cystic appearance on MR imaging. Jpn J Radiol. 27(10):458-61, 2009
                                          13. de Waal YR et al: Secondary ovarian malignancies: frequency, origin, and characteristics. Int J Gynecol Cancer. 19(7):1160-5, 2009
                                          14. Koyama T et al: Secondary ovarian tumors: spectrum of CT and MR features with pathologic correlation. Abdom Imaging. 32(6):784-95, 2007
                                          15. Testa AC et al: Imaging in gynecological disease (1): ultrasound features of metastases in the ovaries differ depending on the origin of the primary tumor. Ultrasound Obstet Gynecol. 29(5):505-11, 2007
                                          16. Chang WC et al: CT and MRI of adnexal masses in patients with primary nonovarian malignancy. AJR Am J Roentgenol. 186(4):1039-45, 2006
                                          17. Khunamornpong S et al: Primary and metastatic mucinous adenocarcinomas of the ovary: Evaluation of the diagnostic approach using tumor size and laterality. Gynecol Oncol. 101(1):152-7, 2006
                                          18. Kiyokawa T et al: Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol. 30(3):277-99, 2006
                                          19. Alcazar JL et al: Transvaginal gray scale and color Doppler sonography in primary ovarian cancer and metastatic tumors to the ovary. J Ultrasound Med. 22(3):243-7, 2003
                                          20. Jung SE et al: CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 22(6):1305-25, 2002
                                          21. Brown DL et al: Primary versus secondary ovarian malignancy: imaging findings of adnexal masses in the Radiology Diagnostic Oncology Group Study. Radiology. 219(1):213-8, 2001
                                          22. Hann LE et al: Adnexal masses in women with breast cancer: US findings with clinical and histopathologic correlation. Radiology. 216(1):242-7, 2000
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                TERMINOLOGY

                                                • Definitions

                                                  • Secondary (metastatic) neoplasms to ovary
                                                  • Krukenberg tumor
                                                    • Subtype of metastatic tumors that contain > 10% mucin-filled signet cells in cellular stroma
                                                    • Usually from gastrointestinal tract, with 76% arising from stomach
                                                    • Krukenberg tumor is sometimes used inappropriately by some to include all metastatic ovarian carcinomas
                                                  • High-stage mucinous tumors involving ovary frequently represent metastases from extraovarian primary sites and are often misdiagnosed as primary ovarian mucinous tumors

                                                IMAGING

                                                • General Features

                                                  • Ultrasonographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Nuclear Medicine Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Jeung YJ et al: Krukenberg tumors of gastric origin versus colorectal origin. Obstet Gynecol Sci. 58(1):32-9, 2015
                                                                                  2. Nakamura Y et al: A Krukenberg Tumor from an Occult Intramucosal Gastric Carcinoma Identified during an Autopsy. Case Rep Oncol Med. 2014:797429, 2014
                                                                                  3. Alvarado-Cabrero I et al: Metastatic ovarian tumors: a clinicopathologic study of 150 cases. Anal Quant Cytol Histol. 35(5):241-8, 2013
                                                                                  4. La Fianza A et al: Intralesional hemorrhage in Krukenberg tumor: a case report and review of the literature. J Ultrasound. 16(2):89-91, 2013
                                                                                  5. Guerriero S et al: Preoperative diagnosis of metastatic ovarian cancer is related to origin of primary tumor. Ultrasound Obstet Gynecol. 39(5):581-6, 2012
                                                                                  6. Ho L et al: Bilateral ovarian metastases from gastric carcinoma on FDG PET/CT. Clin Nucl Med. 37(5):524-7, 2012
                                                                                  7. Willmott F et al: Radiological manifestations of metastasis to the ovary. J Clin Pathol. 65(7):585-90, 2012
                                                                                  8. Kitajima K et al: FDG PET/CT features of ovarian metastasis. Clin Radiol. 66(3):264-8, 2011
                                                                                  9. Maeda-Taniguchi M et al: Metastatic mucinous adenocarcinoma of the ovary is characterized by advanced patient age, small tumor size, and elevated serum CA125. Gynecol Obstet Invest. 72(3):196-202, 2011
                                                                                  10. Soslow RA: Mucinous ovarian carcinoma: slippery business. Cancer. 117(3):451-3, 2011
                                                                                  11. Zaino RJ et al: Advanced stage mucinous adenocarcinoma of the ovary is both rare and highly lethal: a Gynecologic Oncology Group study. Cancer. 117(3):554-62, 2011
                                                                                  12. Abe Y et al: A case of metastatic malignant melanoma of the ovary with a multilocular cystic appearance on MR imaging. Jpn J Radiol. 27(10):458-61, 2009
                                                                                  13. de Waal YR et al: Secondary ovarian malignancies: frequency, origin, and characteristics. Int J Gynecol Cancer. 19(7):1160-5, 2009
                                                                                  14. Koyama T et al: Secondary ovarian tumors: spectrum of CT and MR features with pathologic correlation. Abdom Imaging. 32(6):784-95, 2007
                                                                                  15. Testa AC et al: Imaging in gynecological disease (1): ultrasound features of metastases in the ovaries differ depending on the origin of the primary tumor. Ultrasound Obstet Gynecol. 29(5):505-11, 2007
                                                                                  16. Chang WC et al: CT and MRI of adnexal masses in patients with primary nonovarian malignancy. AJR Am J Roentgenol. 186(4):1039-45, 2006
                                                                                  17. Khunamornpong S et al: Primary and metastatic mucinous adenocarcinomas of the ovary: Evaluation of the diagnostic approach using tumor size and laterality. Gynecol Oncol. 101(1):152-7, 2006
                                                                                  18. Kiyokawa T et al: Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol. 30(3):277-99, 2006
                                                                                  19. Alcazar JL et al: Transvaginal gray scale and color Doppler sonography in primary ovarian cancer and metastatic tumors to the ovary. J Ultrasound Med. 22(3):243-7, 2003
                                                                                  20. Jung SE et al: CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 22(6):1305-25, 2002
                                                                                  21. Brown DL et al: Primary versus secondary ovarian malignancy: imaging findings of adnexal masses in the Radiology Diagnostic Oncology Group Study. Radiology. 219(1):213-8, 2001
                                                                                  22. Hann LE et al: Adnexal masses in women with breast cancer: US findings with clinical and histopathologic correlation. Radiology. 216(1):242-7, 2000