Sonographic appearance of Krukenberg tumors: a rare case report

Abstract

Kruckenberg tumor is a metastatic lesion of the ovary, the source of which is the primary cancerous focus in other organs (generally in the digestive system); it often causes difficulties in differential diagnosis with primary ovarian cancer. We report a case of a 67-year- old woman who presented bilateral, 3 cm in diameter, pure solid, encapsulated and hyperechoic smooth masses, surrounded by a hypoechoic ring with clear tumor margins. Doppler ultrasonography revealed abundant vascularization, with a characteristic tree- shaped structure penetrating from the periphery into the central part of the lesion with low impedance and diminished vascular resistance. Approximately 5% to 10% of all ovarian malignancies are metastatic carcinomas. Asymmetrically enlarged bilateral encapsulated masses, with variable intratumoral echogenic density, and ascites are the main characteristics of sonography of Krukenberg tumors. The structure of these tumors is usually hyperechoic with abundant vascularization. Several sonographic markers have been used to show the low impedance of intratumoral circulation in ovarian malignancy, attributing this to the active angiogenesis of these tumors. Krukenberg tumors have a poor prognosis, with an overall 5-year survival rate of 12%. Hence prophylactic bilateral oophorectomy is recommended for women with stomach cancer.