Ovarian metastases of intestinal-type gastric carcinoma: A clinicopathologic study of 4 cases with contrasting features to those of the Krukenberg tumor

James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Department of Pathology, Harvard Medical School, Boston, MA 02114, USA.
American Journal of Surgical Pathology (Impact Factor: 4.59). 12/2006; 30(11):1382-8. DOI: 10.1097/01.pas.0000213256.75316.4a
Source: PubMed

ABSTRACT Ovarian metastases of intestinal-type gastric adenocarcinomas are rare, and information on them is very limited compared with that on signet-ring cell carcinomas that result in the Krukenberg tumor. Four cases are reported herein. The patients averaged 55 years of age. In 3 patients, the ovarian metastases were identified several to 21 months after the diagnosis of the gastric primary, and the tumors were synchronous in the fourth. Two tumors were bilateral, 1 unilateral, and for 1, the laterality was unknown. The ovarian tumors were characteristically solid and cystic, with multinodular growth in 2. In 2 cases, the ovarian tumors had a pseudoendometrioid morphology with tubulo-glandular, cribriform, and papillary patterns; they also had focal trabecular and insular patterns. Prominent necrosis was present, including segmental and intraluminal "dirty" necrosis. In the other 2 cases, the ovarian tumors had a mucinous appearance, 1 being dominantly cystic with occasional goblet cells and the other with prominent foveolar-type cells. Nuclei ranged from deceptively bland to highly atypical. Surface implants were identified in 2 cases. Two ovarian tumors examined expressed cytokeratin 7 and 20 but not estrogen receptor. Three patients with follow-up information all died within 1 year of the ovarian metastases. Although information is limited, our results suggest that metastatic spread to the ovary by intestinal-type gastric adenocarcinoma is usually seen in patients older than those with Krukenberg tumors, with a known history of gastric carcinoma, and with concomitant widespread disease. Involvement of the ovary by intestinal-type gastric carcinoma produces a microscopic picture distinctly different from that of a Krukenberg tumor. These metastatic intestinal-type tumors may be confused with metastases from other gastrointestinal sites that are more frequently the cause of pseudoendometrioid or mucinous metastases, and like such tumors may be confused with primary ovarian endometrioid and mucinous neoplasms.

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    • "2/3 of the primary tumors originate in the stomach, with other primary sites, by order of frequency, being: appendix, colon, breast, small intestine, rectum, gallbladder and urinary bladder (Kiyokawa et al, 2006). Signet ring cell carcinomas metastasize to the ovary more than twice as often as intestinal-type carcinomas (Lerwill and Young, 2006). It is important to note that some of these patients may have signs or symptoms related to ovarian stromal luteinization particularly during pregnancy, with androgenic manifestations. "
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    ABSTRACT: The occasional finding of simultaneous or metachronous multiple primary cancers in the upper genital tract may represent metastasis from one location to another or independent primary tumors. The overall survival of patients with simultaneous primary cancers of the ovary and uterus suggests multifocal rather than metastatic disease. Diagnosis relies upon conventional clinicopathological criteria. The distinction is important because the prognosis and treatment are different. Metastases to the female genital tract occur frequently in the ovary, sometimes the ovarian tumor being primarly manifested although the extragenital tumor remains occult. In perspective, global genetic profiling should determine the potential prognostic relevance of specific molecular alterations, by correlation of profiling data with patient outcome.
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    ABSTRACT: Introduction et but du travailLes tumeurs de Krukenberg (TK) se définissent comme des métastases ovariennes bilatérales d’un cancer le plus souvent digestif. Elles sont rares et représentent 1 à 2 % des tumeurs ovariennes. Nous en rapportons trois observations. ObservationsLa première patiente, âgée de 19 ans, était hospitalisée pour masse abdominopelvienne objectivée à l’examen clinique et à l’échographie abdominopelvienne. La laparotomie avait mis en évidence deux tumeurs ovariennes dont l’étude histologique était en faveur de métastases ovariennes d’un carcinome d’origine digestive. La fibroscopie oesogastrique montrait un adénocarcinome sous-cardial moyennement différencié. Une chimiothérapie palliative était indiquée. La patiente décédait après deux mois. Le deuxième cas était révélé par une péritonite aiguë par perforation d’une tumeur gastrique antrale chez une patiente de 46 ans. L’exploration de l’étage pelvien avait retrouvé deux tumeurs ovariennes bilatérales. L’étude histologique des biopsies peropératoires était en faveur d’un adénocarcinome gastrique. En raison de l’altération importante de son état général, un traitement symptomatique était proposé. Elle était perdue de vue après deux mois. La troisième patiente, âgée de 40 ans, présentait des épigastralgies chroniques. La fibroscopie oesogastrique avait objectivé un carcinome à cellules indépendantes de la région antrofundique. La tomodensitométrie thoracoabdominopelvienne avait montré deux tumeurs ovariennes de 30 mm à droite et de 80 mm à gauche. Une chimiothérapie palliative était indiquée. ConclusionLes TK sont rares. Les traitements demeurent palliatifs et ne sont pas codifiés. Des progrès de la chimiothérapie pourraient améliorer le pronostic de ces tumeurs qui demeure sombre. Introduction and aim of the workThe Krukenberg tumors are defined as bilateral ovarian metastasis of a generally digestive cancer. They are rare and account for 1–2% of the ovarian tumors. We report three observations of Krukenberg tumors. PatientsThe first patient was a 19-year-old young woman admitted for an abdominopelvic mass diagnosed clinically and by ultrasonography. The laparotomy highlighted the presence of two ovarian tumors whose histological study revealed metastasis of a carcinoma of digestive origin. The oesogastric fibroscopy showed an undercardial tumor, the histological study of which was a fairly differentiated adenocarcinoma. Chemotherapy was indicated. The patient died in the second month following the diagnosis. The second case was revealed by an acute peritonitis due to a perforated gastric antral tumor in a 46-year-old woman. The exploration of the pelvis found bilateral ovarian tumors. The histology of the biopsies showed a gastric adenocarcinoma. Because of the deterioration of his general state, the patient had only symptomatic treatment. She was followed up consultation for two months; then lost. The third patient was a 40-year-oldwoman who presented during 5 months epigastric pain. Gastric fibroscopy revealed a carcinoma with independent cells. The CT scan showed two ovarian tumors of respectively 30 and 80 mm. Palliative chemotherapy was indicated. ConclusionThe Krukenberg tumors are rare; their treatment is palliative and is still not codified. Progress in chemotherapy could ameliorate the prognosis of these tumors that is still dark. Mots clésTumeur de Krukenberg-Carcinome-Cancer de l’estomac-Endoscopie KeywordsKrukenberg’s Tumor-Carcinoma-Gastric cancer-Endoscopy
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