Krukenberg Tumors: Diagnostic Difficulties, Treatment Strategies, and Survival Outcomes from a 16-Year Study at a Tertiary Women's Hospital

Category	Detail
Condition	Krukenberg tumour, a rare metastatic ovarian malignancy primarily from gastrointestinal tract signet-ring cell carcinomas
Key Mechanisms	Metastasis of cancer cells from primary gastrointestinal or other sites to ovaries via retrograde lymphatic or blood vessels; characterized by mucin-producing signet-ring cells
Target Population	Women, predominantly of reproductive age, including premenopausal patients
Care Setting	Tertiary women's hospital with multidisciplinary management including gynecologic oncology, gastroenterology, and oncology

Krukenberg tumours primarily metastasize from gastrointestinal tract cancers, especially stomach and colon, with a higher incidence in Asian populations.
Diagnosis is challenging due to nonspecific symptoms and difficulty identifying primary tumour sites; preoperative imaging often misclassifies tumours as primary ovarian malignancies.
Treatment strategies include cytoreductive surgery and systemic chemotherapy, with palliative care for widespread metastasis; overall survival remains poor (3-10 months).

Confirm diagnosis via histopathological examination showing signet-ring cells.
Use immunohistochemistry markers (CDX-2, SATB2, CEA, CK20) to identify gastrointestinal origin.
Perform abdominal ultrasound and CT scans preoperatively; frozen section histopathology intraoperatively to guide surgical decisions.
Tumour markers (CA-125, CA-199, CEA) have limited specificity and should not solely guide diagnosis.

Perform cytoreductive surgery to remove primary and metastatic lesions when feasible.
Administer systemic chemotherapy tailored to primary tumour origin, often including platinum-based regimens.
In cases of widespread metastasis where curative surgery is not possible, provide palliative chemotherapy and supportive care.
Engage multidisciplinary teams including gynecologists, gastroenterologists, and oncologists during treatment.

Follow up patients with outpatient visits, repeat ultrasound evaluations, and telephone consultations.
Monitor tumour markers and imaging to assess treatment response and disease progression.

High mortality with median overall survival of 3 to 10 months post-diagnosis.
Diagnostic delays due to nonspecific symptoms and misclassification may worsen prognosis.
Chemotherapy effectiveness remains uncertain and varies depending on primary tumour origin.

Fifteen women diagnosed with Krukenberg tumours over 16 years at a tertiary women’s hospital, mostly premenopausal with mean age 42 years.

Surgical removal of tumours combined with systemic chemotherapy can extend survival in some cases; palliative care is important for advanced disease.

Maintain high suspicion for metastatic ovarian tumours in women presenting with pelvic masses and nonspecific gynecologic symptoms.
Use intraoperative frozen section histopathology to confirm diagnosis and guide immediate surgical management.
Coordinate multidisciplinary care involving gynecologic oncologists, gastroenterologists, and medical oncologists.
Prioritize early diagnosis and surgical resection of both primary and metastatic lesions to improve survival outcomes.

Clinical Scorecard: Krukenberg Tumors: Diagnostic Difficulties, Treatment Strategies, and Survival Outcomes from a 16-Year Study at a Tertiary Women's Hospital