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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 518-519

Bilateral krukenberg tumor in a case of carcinoma stomach: Ultrasonography and doppler findings


Department of Radio Diagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

Date of Submission11-Jun-2020
Date of Decision20-Jul-2020
Date of Acceptance30-Jul-2020
Date of Web Publication1-Feb-2021

Correspondence Address:
Dr. Suresh Phatak
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Sawangi, Meghe, Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_222_20

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How to cite this article:
Tapadia S, Phatak S. Bilateral krukenberg tumor in a case of carcinoma stomach: Ultrasonography and doppler findings. J Datta Meghe Inst Med Sci Univ 2020;15:518-9

How to cite this URL:
Tapadia S, Phatak S. Bilateral krukenberg tumor in a case of carcinoma stomach: Ultrasonography and doppler findings. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Feb 25];15:518-9. Available from: http://www.journaldmims.com/text.asp?2020/15/3/518/308560



Respected Sir,

We are presenting ultrasonography and Doppler imaging of bilateral Kruckenberg tumor in a histopathologically proven case of gastric adenocarcinoma in a 47-year-old female patient who presented with severe pain and distension of the abdomen, early onset menopause, loss of appetite, and a drop in weight by about 16 kg.

Krukenberg tumor, accounts for 1%–2% of all ovarian tumors. It is a rare metastatic tumor of the ovary. The stomach is the most common site for primary carcinoma in about 75% of Krukenberg tumor cases, followed by carcinomas of the breast, appendix, small intestine, gallbladder, urinary bladder, biliary tract, pancreas, ampulla of Vater, and uterine cervix. Krukenberg tumor has a poor prognosis and occurs in the late stage of the disease. A significantly differentiating feature of Kruckenberg tumor from other tumors is that it occurs bilaterally in about 80% of the cases.[1] The tumor is thought to spread via 1 of the 3 mechanisms: (1) The lymphatic system, (2) The hematogenous system, or (3) The transcoelomic pathway (means the actual cancer cells directly spread through the abdominal route to adjacent organs).

Krukenberg tumors range in size from 5 to 20 cm. Irrespective of the size of the tumor, affected ovaries retain their shape. Histopathologically, these tumors exhibit the presence of signet ring cells and pseudosacroma proliferation of ovarian stroma.[2]

Radiologically, Krukenberg tumors appear as complex semisolid masses with varying proportions of solid and cystic components. Where the solid component occurs due to secondary lymphomatous involvement of the ovary usually from the upper gastrointestinal tract and the cystic component occur due to colonic primaries.[3]

Transabdominal ultrasound of abdomen and pelvis with convex transducer revealed free fluid in the peritoneal cavity [Figure 1] and right ovary measuring 6.8 cm × 3.7 cm, whereas the left ovary measuring 5.7 cm × 3.2 cm with bilateral ovaries showed solid-cystic masses in the pelvis, cystic component is well-defined round to oval in shape, appearing anechoic with internal debris and the solid component is appearing heterogeneously hyperechoic [Figure 2]a and [Figure 2]b.
Figure 1: Gray-scale ultrasound imaging showing evidence of anechoic free fluid in the peritoneal cavity

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Figure 2: (a and b) Gray-scale ultrasound imaging showing right ovary measuring 6.8 cm × 3.7 cm and left ovary measuring 5.7 cm × 3.2 cm. Solid–cystic masses in bilateral ovaries exhibiting well defined round anechoic cystic component with internal debris (yellow arrow) and heterogeneously hyper echoic solid component (white arrow)

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The solid component exhibited internal vascularity on Doppler, while the cystic component exhibited vascular uptake in the periphery [Figure 3].[4],[5],[6],[7],[8]
Figure 3: Doppler ultrasound imaging showing solid–cystic masses with peripheral uptake in the cystic component (yellow arrow) and internal vascularity in the solid component (white arrow)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gligorievski A. Appearance of Krukenberg tumor from gastric carcinoma, ultrasound and computed tomography evaluation, Dig Med Res 2018;1:1-6.  Back to cited text no. 1
    
2.
Hiremath R, Padala KP, Mahesh , Gowda G, Pailoor A. Bilateral krukenberg tumours diagnosed primarily by transabdominal sonography A case report. J Clin Diagn Res 2015;9:TD01-3.  Back to cited text no. 2
    
3.
Lyngdoh BS, Dey B, Mishra J, Marbaniang E. Krukenberg tumor. Autops Case Rep 2020;10:10.  Back to cited text no. 3
    
4.
Jain A, Bhake A, Vagha S, Narkhede R. Correlation of Carcinoma Antigen (Ca 15-3) Serum Assay with Clinicopathological Parameters in Women with Invasive Ductal Carcinoma. Int J Pharm Res 2019;11: 1193-7. Available from : https://doi.org/10.31838/ijpr/2019.11.01.211. [Last accessed on 2020 Mar 08].  Back to cited text no. 4
    
5.
Spencer LJ, Castle CD, Dingels ZV, Fox JT, Hamilton EB, Liu Z, Roberts NL, et al. Estimating Global Injuries Morbidity and Mortality: Methods and Data Used in the Global Burden of Disease 2017 Study.” Injury Prevention 2020;26:i125-53.Available from : https://doi.org/10.1136/injuryprev-2019-043531. [Last accessed on 2020 Mar 08].  Back to cited text no. 5
    
6.
Jaiswal N, Makrande J, Bhake A, Bapat AV. Ema, Vimentin, Desmin, Calretinin, e-Cadherin on Cell Block to Differentiate Adenocarcinoma Cells from Benign Reactive Mesothelial Cells. International Journal of Pharmaceutical Research 2019;11:1860-4. Available from : https://doi.org/10.31838/ijpr/2019.11.02.213. [Last accessed on 2020 Mar 08].  Back to cited text no. 6
    
7.
Mishra P, Vagha S, Shukla S, Chaudhari SS. Correlation of Cytokeratin Expression with Bloom Richardson Grading of Carcinoma Breast in Rural Setup. Int J Pharm Res 2019;11:1844-8. Available from :https://doi.org/10.31838/ijpr/2019.11.02.209. [Last accessed on 2020 Mar 08].  Back to cited text no. 7
    
8.
Patwa P, Phatak S, Pattabiraman S, Marfani G. Ultrasound and Color Doppler Features of Transitional Cell Carcinoma of the Endometrium with Pathological Correlation. J Datta Meghe Inst Med Sci Univ 2019;14:429-31. Available from :https://doi.org/10.4103/jdmimsu.jdmimsu_198_19. [Last accessed on 2020 Mar 08].  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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