Bilateral Krukenberg tumor of the ovary during pregnancy

This case report concerns a 35-year-old woman suffering from gravidic cholestasis, thrombocytosis and iterative vomiting episodes who underwent an elective cesarean section at week 35 because of recent herpetic vulvitis. Large bilateral ovarian tumors were observed which were interpreted as pregnancy luteomas. Nevertheless a biopsy of the right ovary was performed. Histologic examination revealed massive luteinization of the ovarian stroma. In addition, large tumor cells were found dispersed throughout the ovary as well as in vascular spaces as either isolated or clustered signet-ring cells. In search of the primary tumor, gastroscopy revealed a gastric ulcer in the antrum. The biopsies of the ulcer margins as well as those taken at distance demonstrated signet-ring cells in the lamina propria. Bilateral salpingo-oophorectomy and total gastrectomy were performed. In spite of postoperative chemotherapy, the patient died of disease 5 months after diagnosis.

Krukenberg tumor; Pregnancy; Massive luteinization; Luteoma of pregnancy

[1] Clement PB.: "Tumor-like lesions of the ovary associated with pregnancy". Int. J. Gynaecol. Pathol., 1993, 12, 108.

[2] Mackey J. R., Hugh J., Smylie M.: "Case report. Krukenberg tumor complicated by pregnancy". Gynecol. Oneal., 1996, 61, 153.

[3] Hiroaki U., Matsuoka H., Tamura S.. Sato K., Tsunematsu Y., Kato T.: "Prognosis in gastric cancer associated with pregnancy". World 1. Surg., 1991, 15, 293.

[4] Lo S. S. T.,F erguson S. A.,L ee C. P.,Ye ung C.: "Carcmoma of the stomach complicating pregnancy". 1. Clin. Gastroenterol., 1996, 23, 299.

[5] Hirabayashi M.,U eo H.,O kudaira Y.,M atsumata T., Hanawa S., Sugimachi K.: "Case report. Early gastric cancer and a concomitant pregnancy". Am. Surg., 1987, 53, 730.

[6] Scharl A., Huber P., Lorenzen J., Gohring U-J.: "Gastric cancer during early pregnancy. Two case reports". Arch Gynecol. Obst., 1996, 258, 151.

[7] Ulbright T. N., Roth L. M., Stehman F. B.: "Secondary ovarian neoplasia: a clinico-pathologic study of 35 cases". Cancer, 1984, 53,1164.

[8] Nagamani M., Gomez L. G., Garza J.: "In vivo steroid studies in luteoma of pregnancy". Obstet. Gynecol., 1982, 59, 105S.

[9] Scully R. E., Richardson G. S.: "Luteinization of the stroma of the metastatic cancer involving the ovary and its endocrine significance". Cancer, 1961, 14, 827.

[10] Yamawaki T., Hirai Y.,Takeshima N.: "Ovarian hemangioma associated with concomitant stromal luteinization and ascites". Gynecol. Oncol., 1996, 61, 438.

[11] Mittal K. R.,B lechman A.,G reco M. A.,A lfonso F., Demopoulos R.: "Lymphoma of the ovary with stromal luteinization presenting as secondary amenorrhea". Gynecol. Oncol., 1992, 45, 69.

[12] Scully R. E.: "Ovarian tumors with functioning stroma". In: Haines and Taylor Obstetrical and Gynecological Pathology, H. Fox Ed. Churchill Livingston, Edinburgh, 1987, 724.

[13] Matley P. J.,D ent D. M.,M adden M. V.,P rice S. K.: "Gastric carcinoma in young adults". Am. Surg., 1988, 208, 539.

[14] Nesbitt C. J., Moise J. K., Sawyers L. J.: "Colorectal carcinoma in pregnancy". Arch. Surg., 1985, 120, 636.

[15] Furukawa H., lwanaga T., Hiratsuka M., Imaoka S., Ishikawa O., Kabuto T., Sasaki Y. et al.: "Gastric cancer in young adults: growth accelerating effect of pregnancy and delivery". J. Surg. Oncol., 1994, 55, 3.