Ovarian metastasis accounts for up to 30% of all ovarian malignancies. The term "Krukenberg tumor" is used in practice to include all metastatic ovarian tumors although only 40% of ovarian metastases are due to Krukenberg tumor which is a signet cell gastrointestinal malignancy [1]. Cancerous tumors from several organ systems, such as gastrointestinal and female genital tract, could spread to the ovaries [2]. Of these, the commonest are from the breast, colon, and stomach [2]. Lymphatic spread of tumor is faster and more common from the stomach to the ovaries than from the colon while the vascular spread is higher from the colon than from the stomach [2].

A majority of patients with ovarian metastases may be asymptomatic. When they present with symptoms, either the primary malignancy may be diagnosed concomitantly or may have been identified earlier [1] [3]. In addition to clinical manifestations of the primary malignancy, patients may complain of abdominal pain, swelling [4], bloating, and increase in abdominal girth (due to ascites) [5]. Hypertrophy of the ovarian tissue may result in endocrine manifestations such as virilization [6]. Common symptoms and signs of a malignancy such as weight loss, anorexia, easy fatiguability, asthenia, nausea, vomiting, and diarrhea may also be present. In addition, patients may complain of dysuria, increased frequency of micturition, and constipation due to compression of neighboring organs by the enlarged ovaries. Lower limb deep vein thrombosis and paraneoplastic syndromes are some of the other manifestations in individuals with ovarian metastases.

Krukenberg tumors are associated with bilateral, asymmetrical enlargement of the ovaries without peritoneal adhesions and deposits while metastases from other tumors are embedded within the ovarian capsule or in the peritoneum [1].

• Pathologist

  After putting together the clinical findings, special studies on tissues (if needed), and the microscope findings, the pathologist arrives at a definitive diagnosis. [dovemed.com]

  Krukenberg, German pathologist (1871-1946) who first described them in 1896. ovarian tumors Promoted articles (advertising) [radiopaedia.org]

  To do this, a pathologist checks the removed tissue samples (called biopsies) from your reproductive organs. In addition, the surgeon will usually remove specific lymph nodes. [mnovarian.org]

  The operation is paused while the pathologist rapidly reviews the biopsy tissues. The pathologist's report determines the structures affected by cancer and if they should be removed. This spares the woman from undergoing another surgery. [emedicinehealth.com]

  Twaalhoven 1999,Houck 2000, Tempfer 2007, Brun 2008 Accuracy for malignancy of epithelial OvTu 90-94% Accuracy for borderline tumors approx. 60-70% Factors: % Borderlinekomponente (10) Type (muc), Size of tumor (10/3) Experience of Pathologist Additional [slideserve.com]

• Abdominal Pain

  After receiving a 6 course first line chemotherapy and 8 course maintenance therapy, the patient suffered acute abdominal pain, so surgery was performed. [ncbi.nlm.nih.gov]

  In addition to clinical manifestations of the primary malignancy, patients may complain of abdominal pain, swelling, bloating, and increase in abdominal girth (due to ascites). [symptoma.com]

  Clinical description Malignant SCST of ovary may occur at any age but usually occurs in child bearing or post menopausal age groups, presenting with manifestations of mass effect (abdominal pain or distention, gastrointestinal symptoms, or abdominal mass [orpha.net]

  In such cases, the signs and symptoms associated with the accompanying syndrome may exist Following are the common signs and symptoms associated with this tumor type: Abdominal pain (the pain is usually a pelvic pain) Abdominal swelling due to the mass [dovemed.com]

• Pelvic Mass

  A 5-year-old girl with stage M neuroblastoma presented with an upper abdominal and a pelvic mass. Evaluation after induction showed very good tumour response with three remaining localisations: two abdominal and one pelvic. [ncbi.nlm.nih.gov]

• Gagging

  […] tumor suppressor and consequently render ovarian CSC properties and EMT phenotypical transformation ( 21 ). microRNAs and Extracellular Matrix Modification Extracellular matrix (ECM) is composed of interlocking fibrous proteins and glycosaminoglycans (GAGs [frontiersin.org]

• Hypertension

  […] pathophysiological pathway in Kounis syndrome and non allergic acute coronary syndrome Domina Petric Int J Med Rev Case Rep. 2022; 6(14): 14-15 » Abstract » PDF» doi: 10.5455/IJMRCR.172-1644937731 Case Report Death due to Pulmonary Embolism and Pulmonary Hypertension [mdpub.net]

• Jaundice

  […] ovary by several pathways: Direct spread Transcoelomic dissemination Hematogeneous spread Lymphatic spread ( Obstet Gynecol Int 2011;2011:612817 ) Clinical features Symptoms of primary tumor with or without abdominal mass / pain / rectal bleeding / jaundice [pathologyoutlines.com]

  Some common signs of metastatic cancer include: Pain and fractures, when cancer has spread to the bone Headache, seizures, or dizziness, when cancer has spread to the brain Shortness of breath, when cancer has spread to the lung Jaundice or swelling in [cancer.gov]

• Fracture

  Some common signs of metastatic cancer include: Pain and fractures, when cancer has spread to the bone Headache, seizures, or dizziness, when cancer has spread to the brain Shortness of breath, when cancer has spread to the lung Jaundice or swelling in [cancer.gov]

• Dizziness

  Some common signs of metastatic cancer include: Pain and fractures, when cancer has spread to the bone Headache, seizures, or dizziness, when cancer has spread to the brain Shortness of breath, when cancer has spread to the lung Jaundice or swelling in [cancer.gov]

• Pelvic Pain

  Abdominal or pelvic pain, abdominal bloating, or pain during intercourse, may be the presenting symptom. Irregular bleeding may also be seen. Median patient age at presentation is 48 years. [radiopaedia.org]

  pain, bloating, ascites, or pain during sexual intercourse. [en.wikipedia.org]

  In such cases, the signs and symptoms associated with the accompanying syndrome may exist Following are the common signs and symptoms associated with this tumor type: Abdominal pain (the pain is usually a pelvic pain) Abdominal swelling due to the mass [dovemed.com]

  We repot the case of a 36-year-old woman who was admitted in our hospital with pelvic pain and ascites and also with suspicion of peritoneal carcinomatosis. [medichub.ro]

  The first case of EOPPC was reported by Swerdlow in 1959.[7] He described a 27-year-old woman experiencing pelvic pain, who, upon examination, was found to have an adnexal mass. [cancernetwork.com]

• Hematuria

  […] endothelial growth factor receptor inhibition can paradoxically accelerate tumor invasiveness and metastasis in certain models. [1] The present case is about a 48-year-old, female patient had presented fullness of abdomen, right flank pain and on and off hematuria [urologyannals.com]

A working diagnosis of ovarian metastasis is made on clinical suspicion and physical examination findings while confirmation requires histological examination of either ovarian tissue or ascitic fluid. So the workup consists of a detailed history, thorough physical examination, laboratory tests, imaging studies, and pathohistological examination. History may or may not elicit clinical manifestations of a concurrent primary tumor.

Urinalysis is performed to rule out renal causes of symptoms. Tumor markers like beta-human chorionic gonadotropin, alpha-fetoprotein, lactate dehydrogenase, and cancer antigen-125 (CA 125) are not diagnostic [1]. Imaging studies include abdominal and pelvic ultrasonography or computed tomography (CT) along with chest X-ray to exclude pulmonary metastases and mammography to rule out breast malignancy [7] [8]. Positron emission tomography (PET) is indicated either to look for primary tumors or confirm the presence of metastatic lesions [9]. Magnetic resonance imaging (MRI) may be considered, although it is not confirmatory [10].

Histopathology of ovarian tissue or ascitic fluid and immunohistochemistry is required to confirm the diagnosis [1]. Microscopically, signet ring cells filled with mucin are characteristic of Krukenberg tumors and the cells are immunoreactive to epithelial markers such as epithelial membrane antigen and cytokeratins but nonreactive to vimentin and inhibin [11] [12].

Gastrointestinal (GI) endoscopy or GI imaging with barium enema may be necessary to look for primary tumors in patients with suspected gastric or colorectal malignancies.

• Ovarian Mass

  After three treatments, a check-up with computed tomography demonstrated the presence of a right ovarian mass. An ovariectomy was performed, and the pathological examination confirmed the diagnosis of an ovarian metastasis from an ocular melanoma. [ncbi.nlm.nih.gov]

  However, there are no highly specific radiological features that differentiate primary from metastatic ovarian masses. [jcp.bmj.com]

There have been several reports about successful fertility-preserving treatment of endometrial carcinoma with subsequent pregnancy. However, conservative hormonal treatment for early-stage endometrial cancer still entails some risk. [ncbi.nlm.nih.gov]

The lymph node status was of importance to determine the prognosis of patients with ovarian metastasis. [ncbi.nlm.nih.gov]

Conclusion: Ovarian metastasis in patients with endometrial carcinoma is associated with poor prognosis, the depth of myometrial invasion, lymph node metastasis and histologic types are independent risk factors affecting the prognosis. [link.springer.com]

Etiology Metastases to the ovary commonly arise from the gastrointestinal tract, breast, lungs and contralateral ovaries. [radiopaedia.org]

Etiology Mutations in the DICER1 (14q32.13) gene have been found to be a susceptibility factor for SCST, particularly in malignant Sertoli-Leydig cell tumor of ovary. [orpha.net]

(Etiology) The exact cause of Mucinous Adenocarcinoma of Ovary is unknown in many cases. [dovemed.com]

Ki 67 positive 50% - IHC x40 Discussions Ovarian high-grade carcinoma in young women is rare and of unknown etiological factors, since current incriminated risk agents such as nulliparity, increased number of menstrual cycles, oral contraceptive use are [medichub.ro]

(See Etiology.) Ovarian cancer is the most common cause of cancer death from gynecologic tumors in the United States. [emedicine.medscape.com]

Eltabbakh GH, Piver MS, Natarajan N, et al: Epidemiological differences between women with extra-ovarian primary peritoneal carcinoma and women with epithelial ovarian cancer. Obstet Gynecol 91:254-259, 1998. 20. [cancernetwork.com]

Ovarian preservation in young patients with stage I cervical adenocarcinoma: a surveillance, epidemiology, and end results study. International Journal of Gynecological Cancer. 24(8):1513-20, 2014 Oct. Abstract. [rcog.org.uk]

Summary Epidemiology Age related incidence rate was found to be 1 per 500,000 women. Sex cord stromal tumors constitute about 5% of ovarian malignancies. [orpha.net]

Below is the relative five-year survival rate for epithelial ovarian cancer: Below is the relative five-year survival rate for ovarian stromal tumors: Below is the relative five-year survival rate for ovarian germ cell tumors: The Surveillance, Epidemiology [healthline.com]

(See Epidemiology.) Early disease causes minimal, nonspecific, or no symptoms. Therefore, most cases are diagnosed in an advanced stage. [emedicine.medscape.com]

Most common metastases are from endometrium, appendix (adenocarcinoid or mucinous adenocarcinoma), breast, colon, carcinoid, pancreas and stomach Metastatic mucinous carcinomas are most difficult to distinguish from primary mucinous ovarian neoplasm Pathophysiology [pathologyoutlines.com]

Mahmutovic, Alma Mizdrak, Amina Luckin, Zineta Mulaosmanovic, Amela Salihovic, Almedina Alihodzic Int J Med Rev Case Rep. 2022; 6(14): 5-13 » Abstract » PDF» doi: 10.5455/IJMRCR.172-1638393956 Letter to the Editor Potential clinical relevance of the common pathophysiological [mdpub.net]

Pathophysiology Historically, most theories of the pathophysiology of ovarian cancer included the concept that it begins with the dedifferentiation of the cells overlying the ovary. [emedicine.medscape.com]

These novel findings provide key insights that are applicable to basic cancer research and to the prevention and treatment of cancer. [dovepress.com]

BRCA genes are involved with repairing damaged DNA and normally work to prevent the development of cancer. [texasoncology.com]

Preventive Services Task Force Reaffirmation Recommendation Statement. USPSTF [On-line information].Available online at http://www.uspreventiveservicestaskforce.org/uspstf12/ovarian/ovarartaddend.htm.Accessed October 2012. [labtestsonline.it]

There is no evidence as yet for any maintenance chemotherapy to prevent or delay relapse. NICE guidelines recommend paclitaxel or PLD for recurrent disease but not alternatives gemcitabine, trabectedin or topotecan [ 23 ]. [patient.info]

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