Clinicopathological Analysis of Krukenberg Tumor Arising from Stomach Cancer

ABSTRACT

BACKGROUND: The Krukenberg tumor (KT) is a metastatic or primary ovarian tumor of the signet-ring cell type. The incidence of this tumor is higher in Korea than in Western countries due to the higher incidence of gastric cancer in Korea. This tumor arises more commonly in the relatively young age group, especially women in the prememopausal period. We tried to find the clinicopathological (CP) characteristics of this tumor and also tried to confirm the appropriateness of the classification by the Japanese Research Society for Gastric Cancer which classifies a KT as P2. METHODS: We observed 23 cases of KT which were diagnosed from July 1984 to December 1997 at the Department of General Surgery, Hanyang University Hospital and analyzed their CP factors. RESULT: The age distribution ranged from 30 to 67 years old, and the mean age was 43.3 years old. The most common symptom was lower abdominal pain. The tumor occurred at the bilateral ovaries in 17 cases (74%). Two patients who manifested a KT without other metastatic findings during gastric cancer surgery survived 20 months and 8 months (still alive), whereas 21 cases with peritoneal seeding (PS)(P2) and 6 cases which manifested a KT combined with PS had mean survival durations (MSD) of 7.4 months and 7.2 months, respectively. The MSDs for three patterns of recurrence were 21.4 months for KT cases (8 cases), 21.4 months for PS cases (47 cases), and 5.0 months for KT combined with PS cases (7 cases). In patients under the age of 50 years old who showed signet-ring cell type gastric cancer, the incidence of a KT as a coincidental finding or as a form of recurrence was 24.1% when the tumor showed serosal invasion. CONCLUSIONS: The prognosis for a patient with a KT was relatively better than that for patient with other forms of PS, which is due to the difference in the resectability of these two forms of P2 cancer.This indicates a need to reconsider the P2 classification. If the gastric cancer with a signet-ring cell type and more than T3 in women under the age of 50 years old, we have to consider the necessity for a preventive oophorectomy because of the high incidence of KTs under such conditions.