Misdiagnosed ovarian Krukenberg tumor during pregnancy with virilization

Krukenberg tumor with pregnancy is rare but it is a challenge for treatment and diagnosis. The authors report a case of a 29-week pregnant patient with a massive bilateral Krukenberg tumor which was misdiagnosed as myoma preoperatively and as ovarian stromal tumor intraoperatively. Prenatally the woman was asymptomatic except for preeclamptic symptoms, but red acne on the skin and elevated testosterone were observed. Pelvic ultrasound detected a heterogeneous solid mass mimicking a subserous myoma. The deterioration of preeclampsia prompted a cesarean section, but the neonate died nine days after he was born.A bilateral adnexal mass was found and considered as stromal tumor by frozen section because of luteinization of the stroma. The final pathology showed low differentiation adenocarcinoma of ovary, which was confirmed by gastric biopsies. The patient had undergone chemotherapy 16 times without surgical debulking and she was in generally well 1.5-year follow-up.

Ovary; Krukenberg tumor; Pregnancy; Virilization; Subserous myoma.

[1] Singhal S.R., Nanda S., Chaudhry P., Sen J., Singhal S.K.: “Metastatic bilateral malignant ovarian tumors associated with pregnancy”. Taiwan J. Obstet. Gynecol., 2009, 48, 167.

[2] Young R.H.: “From krukenberg to today: the ever present problems posed by metastatic tumors in the ovary: part I. Historical perspective, general principles, mucinous tumors including the krukenberg tumor”.Adv. Anat. Pathol., 2006, 13, 205.

[3] Yoshida M., Matsuda H., Furuya K.: “Successful treatment of gastric cancer in pregnancy”. Taiwan J. Obstet. Gynecol., 2009, 48, 282.

[4] Al-Agha O.M., Nicastri A.D.: “An in-depth look at Krukenberg tumor: an overview”. Arch. Pathol. Lab. Med., 2006, 130, 1725.

[5] Kiyokawa T., Young R.H., Scully R.E.: “Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations”. Am. J. Surg. Pathol., 2006, 30, 277.

[6] Kim S.H., Abd Halim S.R., Siddiqui N., Park W.H.: “ Disseminated cancer in pregnancy: krukenberg tumour”. Case Rep. Obstet. Gynecol., 2014, 2014, 216969.

[7] Papantoniou N., Belitsos P., Hatzipapas I., Rodolakis A., Papaspyrou I., Antsaklis A.: “Excessive hirsutism in pregnancy because of Krukenberg tumor”. J. Matern. Fetal Neonatal Med., 2012, 25, 869.

[8] Stojnic J., Stefanovic A., Jeremic K., Kadija S., Jeftovic M., Jeremic J.: “Krukenberg tumor of gastric origin in pregnancy with dismal outcome”. Eur. J. Gynaecol. Oncol., 2011, 32, 356.

[9] Papakonstantinou E., Liapis A., Kairi-Vassilatou E., Iavazzo C., KleanthisC.K., Kondi- Pafiti A.: “Virilizing ovarian Krukenberg tumor in a 27-year-old pregnant woman. A case report and literature review”. Eur. J. Gynaecol. Oncol., 2011, 32, 331.

[10] Genç M., Genç B., Solak A., Gür E., Sezgin C.: “Bilateral Krukenberg tumor in a 16-week pregnant woman”. Eur. J. Gynaecol. Oncol., 2014, 35, 95.

[11] Testa A.C., Licameli A., Di Legge A., Mascilini F., Petruzziello L., Pelagalli M., et al.: “Color Doppler sonographic features of a Krukenberg tumor in pregnancy”. J. Ultrasound Med., 2009, 28, 695.

[12] Lin C.K., Chu T.W., Yu M.H.: “Painless ovarian torsion mimicking a uterine myoma”. Taiwan J. Obstet. Gynecol., 2006, 45, 340.

[13] Sarandakou A., Protonotariou E., Rizos D.: “Tumor markers in biological fluids associated with pregnancy”. Crit. Rev. Clin. Lab. Sci., 2007, 44, 151.

[14] de Palma P., Wronski M., Bifernino V., Bovani I.: “ Krukenberg tumor in pregnancy with virilization. A case report”. Eur. J. Gynaecol. Oncol., 1995, 16, 59.

[15] Hornung M., Vogel P., Schubert T., Schlitt H.J., Bolder U.: “A case of virilization induced by a Krukenberg tumor from gastric cancer”. World J. Surg. Oncol., 2008, 6, 19.

[16] Altman J.F., Lowe L., Redman B., Esper P., Schwartz J.L., Johnson T.M., Haefner H.K.: “Placental metastasis of maternal melanoma”. J.Am. Acad. Dermatol., 2003, 49, 1150.

[17] Miller K., Zawislak A., Gannon C., Millar D., Loughrey M.B.: “Maternal gastric adenocarcinoma with placental metastases: what is the fetal risk? ”. Pediatr. Dev. Pathol., 2012, 15, 237.

[18] Jaspers V.K., Gillessen A., Quakernack K.: “Gastric cancer in pregnancy: do pregnancy, age or female sex alter the prognosis? Case reports and review”. Eur. J. Obstet. Gynecol. Reprod. Biol., 1999, 87, 13.

[19] Sandmeier D., Lobrinus J.A., Vial Y., Delaloye J.F., Genton C.Y.: “ Bilateral Krukenberg tumor of the ovary during pregnancy”. Eur. J. Gynaecol. Oncol., 2000, 21, 58.