Signs and symptoms[edit]

Krukenberg tumors often come to the attention when they cause abdominal or pelvic pain,
bloating, ascites, or pain during sexual intercourse. Krukenberg tumors can occasionally provoke a
reaction of the ovarian stroma which leads to hormone production, that results in vaginal bleeding, a
change in menstrual habits, or hirsutism,[3] or occasionally virilization[4] as a main symptom.
All these symptoms are non-specific and can also arise with a range of problems other than cancer,
and a diagnosis can only be made following confirmatory investigations such as computed
tomography (CT) scans, laparotomy and/or a biopsy of the ovary.

Cause and incidence[edit]

Krukenberg tumors can be seen in all age groups, with an average age of 45 years.[2] In most
countries, cancer that has metastasized to the ovary accounts for only about 1 to 2% of ovarian
cancer;[2] in the remainder, the ovary itself is the primary cancer site. However, in Japan they
represent a much higher percentage of malignancies in the ovary (almost 20%) due to the increased
prevalence of gastric cancer.[2]
Krukenberg tumors account for about 15% of metastatic cancers that initially appear to have arisen
in the ovary, and as such is less common than metastasis arising from ovarian epithelial and germ-
cell tumors.[citation needed]
In people who have had nongynecologic malignancy, approximately 20% of adnexal masses are
malignant, and 60% of these are Krukenberg tumors.[5]

Pathogenesis[edit]
There has been debate over the exact mechanism of metastasis of the tumor cells from the
stomach, appendix or colon to the ovaries. Classically it was thought that direct seeding across the
abdominal cavity accounted for the spread of this tumor, but spread by way of the lymphatic is
considered more likely.[2]Now, retrograde lymphatics are thought to be more important in the
pathogenesis of Krukenberg tumour, since the ovaries in Krukenberg tumour do not show capsular
invasion or a breech of the epithelium lining the surface. The average age of diagnosis of
Krukenberg tumors may partly relate to the relatively increased vascularity of the ovaries.[6]
Microscopically, Krukenberg tumors are often characterized by mucin-secreting signet-ring cells in
the tissue of the ovary;[6] when the primary tumor is discovered, the same signet-ring cells are
typically found. However, other microscopic features can predominate.[6][3] Krukenberg tumors are
most commonly metastases from gastric cancer, particularly adenocarcinoma, or breast
cancer[1] particularly invasive lobular breast carcinoma,[2] but they can arise in the appendix, colon,
small intestine, rectum, gallbladder, and urinary bladder[3] or gallbladder, biliary tract,
pancreas, ampulla of Vater or uterine cervix.[2]
Immunohistochemistry may help in diagnosing Krukenberg tumors from primary ovarian
neoplasms[6] but needs to be applied with discretion.[7] For example, tumors that are immunoreactive
to CEA or cytokeratin 20 (CK20) and negative for cytokeratin 7 (CK7) may be more likely to be of
colorectal origin.[2]