A Case of Krukenberg Tumor which has Developed After Laparotomy for Klatskin Tumor with Increased Levels of CA 19-9 and Prolactin

ABSTRACT

The Krukenberg tumor refers to a wide variety of cancers that metastasize in the ovaries with well defined histopatholoigical characteristics and in over half of all cases they metastasize bilaterally. The ovary is a relatively frequent site of metastasis from malignant neoplasia arising elsewhere in the body- in a majority of instances the gastrointestinal tract, breast or other gynecologic organs. The bile duct and gallbladder are a rare source of metastasis. The microscopic appearance of these metastases is as varied as that of the primary cancers. The best known tumor of this type is a mucin secreting signet-ring cell adenocarcinoma of gastric origin. We report a case of a 50-year-old woman with a Krukenberg tumor with galactorrhea diagnosed by surgical resection. She has a past history of surgical treatment for Klatskin tumor which invaded the Hartman's pouch of gallbladder directly one year before this operation. Histologic examination revealed that the proximal and distal margin of bile duct were free of disease, and the level of CA 19-9 returned to normal at 2 months after surgical intervention. During the period of follow-up, she notified the sudden onset of increased serum level of CA 19-9 with hyperprolactinemia at that time point. However no evidence of hepatic recurrence was found despite pelvic evidence of diffuse recurrence. Radical pelvic surgery was accomplished in this patient by hysterosalpingo-oophorectomy.