Krukenberg Tumor of Breast Origin
ABSTRACT The term Krukenberg tumor refers to metastatic disease of the ovary, especially those metastases containing mucin-secreting signet ring cells. Krukenberg tumor of breast origin is not a frequent condition. Case Report: A 49-year-old postmenopausal woman was admitted with pains in her breast, and masses in both breasts were biopsied. Pathology showed invasive ductal cancer with mucin-secreting signet ring cells. X-rays of the spinal column confirmed metastasis to the thoracic vertebrae, and the patient was found to have stage 4 breast cancer. Treatment consisted of chemotherapy, palliative radiotherapy and adjuvant hormone therapy with tamoxifen. The patient showed good response to treatment and was stable for 2 years. She was admitted to our clinic complaining of pelvic pain. Local recurrence, multicentric bone metastases with a right adnexal mass and ascites were detected. We performed total abdominal hysterectomy, bilateral salpingooophorectomy and appendectomy. The pathological diagnosis of the tumor revealed metastasis of signet ring cell breast cancer to the right ovary. The patient was treated with letrozole 2.5 mg/day and zoledronic acid 4 mg/day and is alive 5 months after surgery. Conclusion: Even though complete response to chemoradiotherapy in advanced breast cancer is possible, Krukenberg tumors of breast origin may be seen in the followup period.
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ABSTRACT: Ovarian metastasis are frequently encountered during the course of breast cancer, concerning one woman in five among those suffering from the disease. These secondary ovarian lesions are usually small and bilateral with a non-cystic pattern and are more likely to be from primary infiltrating lobular carcinoma of the breast. Distinction between ovarian metastasis and primary ovarian cancer may sometimes be difficult and require immunohistochemical stains with various monoclonal antibodies. Primary ovarian cancer remains preponderant however, even in a woman with breast cancer. From a clinical point of view, ovarian metastasis are frequently unknown except in case of peritoneal dissemination. Trans-vaginal ultrasonography scan is the best examination when clinical signs give cause to suspect ovarian tumour. Although, systematic ultrasonography screening, as well as blood screening program using CA 125 and CA 15-3, should not be recommended because they lack sensibility and are too expensive. The development of ovarian metastasis during the course of a breast primary carcinoma is a negative prognostic factor with regards to the presence or absence of peritoneal dissemination.Gynécologie Obstétrique & Fertilité 04/2001; 29(4):308-315. DOI:10.1016/S1297-9589(01)00131-X
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ABSTRACT: The goal was to review cases of metastatic ovarian tumor with respect to their clinical features. Sixty-four patients with pathologically confirmed metastatic ovarian carcinoma, who were treated between 1978 and 2002 at Osaka Medical Center for Cancer and Cardiovascular Diseases (OMCC), were reviewed and the clinical features examined. We found that metastatic tumors accounted for 21.1% (64/304) of malignant ovarian tumors. Of 64 metastatic ovarian tumors, 26 originated from gynecologic organs, and 38, from nongynecologic organs. Gynecologic primary sites were the uterine body (23%), uterine cervix (14%), and fallopian tube (3%). Eight of nine cervical cancers with ovarian metastases were adenocarcinomas. Adenocarcinoma of the uterine cervix metastasized to the ovaries more frequently than squamous cell carcinoma (5.6% vs 0.1%, respectively; P < 0.01). Among 38 cases of metastatic ovarian tumors from nongynecologic organs, Krukenberg tumors, pathologically characterized by the presence of typical signet-ring cells, were found in 11 patients (29%). Most (8/11) had originated in the stomach. Half (19/38) were preoperatively diagnosed as metastases. The 5-year survival rate after resection of metastatic ovarian tumors from gynecologic organs was significantly higher than the rate after resection of such tumors from nongynecologic organs (47% vs 19%, respectively; P = 0.026). Metastatic ovarian tumors are likely to be relatively common in Japan because of the high incidence of gastric cancer. In cases of pelvic tumor, metastatic ovarian tumor should always be included in the differential diagnoses. As the 5-year survival after resection of metastatic ovarian tumor is 19%, even for tumors from nongynecologic organs, it seems worthwhile to consider tumorectomy as the second cytoreduction.Gynecologic Oncology 05/2003; 89(2):314-7. DOI:10.1016/S0090-8258(03)00075-1