Krukenberg Tumors from Gastrointestinal Cancer: Molecular Feature, Treatment, and Outcomes: A Case Series
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Abstract
Introduction: Ovarian metastases from gastrointestinal cancers (Krukenberg tumors) are rare, accounting for 1–2% of all ovarian malignancies. Despite their low incidence, they pose substaintial diagnostic and therapeutic challenges. This study evaluates the clinicopathologic features, molecular profile, treatment strategies, and outcomes of patients with Krukenberg tumors. Methods: Between January 2023 and December 2024, we analyzed 12 ladies diagnosed with Krukenberg tumors of gastrointestinal origin. demographics, tumor characteristics, molecular markers, treatment modalities, and survival outcomes reviewed. Progression-free survival (PFS) and overall survival (OS) were calculated across treatment lines. Our ethical committee approved this study. Results: Primary tumors were colorectal (n=7) and gastric (n=5). Median age was 43 years; five patients were premenopausal. Six had synchronous and six had metachronous ovarian metastases. All tumors were pMMR with low TMB; KRAS mutations were present in 50% of cases, HER2 positivity was observed in one case, and BRAF was wild type in all. Four patients underwent ovarian metastasectomy. Median PFS1, PFS2, and PFS3 were 4.56, 2.13, and 3.3 months, respectively. At two years, 45.5% were alive, 75% of those who had metastasectomy. Conclusion: Krukenberg tumors often affect younger women and exhibit poor response to treatment. Ovarian metastasectomy may improve survival when metastases are isolated. Further research into their immune microenvironment is warranted.
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Copyright (c) 2025 Aref Zribi, Ahmad Al Ghoche, Asim Jamal Shaikh
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Aref Zribi, Department of Medical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, University Medical City, Muscat, Oman.
Department of Medical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, University Medical City, Muscat, Oman.
Asim Jamal Shaikh, Department of Medical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, University Medical City, Muscat, Oman.
Department of Medical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, University Medical City, Muscat, Oman.
[1] Moghazy D, Al-Hendy O, Al-Hendy A. Krukenberg tumor presenting as back pain and a positive urine pregnancy test: a case report and literature review. J Ovarian Res. 2014 Apr 7;7:36. doi: 10.1186/1757-2215-7-36. PMID: 24708577
[2] Ojo J, De Silva S, Han E, Lin P, Wakabayashi M, Nelson R, Lai LL. Krukenberg tumors from colorectal cancer: presentation, treatment and outcomes. Am Surg. 2011 Oct;77(10):1381-5
[3] Tan KL, Tan WS, Lim JF, Eu KW. Krukenberg tumors of colorectal origin: a dismal outcome--experience of a tertiary center. Int J Colorectal Dis. 2010 Feb;25(2):233-8. doi: 10.1007/s00384-009-0796-x
[4] Huang PP, Weber TK, Mendoza C, Rodriguez-Bigas MA, Petrelli NJ. Long-term survival in patients with ovarian metastases from colorectal carcinoma. Ann Surg Oncol. 1998 Dec;5(8):695-8. doi: 10.1007/BF02303479
[5] Bruls J, Simons M, Overbeek LI, Bulten J, Massuger LF, Nagtegaal ID. A national population-based study provides insight in the origin of malignancies metastatic to the ovary. Virchows Arch. 2015 Jul;467(1):79-86. doi: 10.1007/s00428-015-1771-2.
[6] Nakamura Y, Hiramatsu A, Koyama T, Oyama Y, Tanaka A, Honma K. A Krukenberg Tumor from an Occult Intramucosal Gastric Carcinoma Identified during an Autopsy. Case Rep Oncol Med. 2014;2014:797429. doi: 10.1155/2014/797429
[7] Al-Agha OM, Nicastri AD. An in-depth look at Krukenberg tumor: an overview. Arch Pathol Lab Med. 2006 Nov;130(11):1725-30. doi: 10.5858/2006-130-1725-AILAKT
[8] Simons M, Bolhuis T, De Haan AF, Bruggink AH, Bulten J, Massuger LF, Nagtegaal ID. A novel algorithm for better distinction of primary mucinous ovarian carcinomas and mucinous carcinomas metastatic to the ovary. Virchows Arch. 2019 Mar;474(3):289-296. doi: 10.1007/s00428-018-2504-0.
[9] Vang R, Bagué S, Tavassoli FA, Prat J. Signet-ring stromal tumor of the ovary: clinicopathologic analysis and comparison with Krukenberg tumor. Int J Gynecol Pathol. 2004 Jan;23(1):45-51. doi: 10.1097/01.pgp.0000101081.35393.5
[10] Anton C, Carvalho FM, Oliveira EI, Maciel GA, Baracat EC, Carvalho JP. A comparison of CA125, HE4, risk ovarian malignancy algorithm (ROMA), and risk malignancy index (RMI) for the classification of ovarian masses. Clinics (Sao Paulo). 2012;67(5):437-41. doi: 10.6061/clinics/2012(05)06
[11] Heavey SF, Roeland EJ, Tipps AM, Datnow B, Sicklick JK. Rapidly progressive subcutaneous metastases from gallbladder cancer: insight into a rare presentation in gastrointestinal malignancies. J Gastrointest Oncol. 2014 Aug;5(4):E58-64. doi: 10.3978/j.issn.2078-6891.2014.023
[12] Lu LC, Shao YY, Hsu CH, Hsu C, Cheng WF, Lin YL, Cheng AL, Yeh KH. Metastasectomy of Krukenberg tumors may be associated with survival benefits in patients with metastatic gastric cancer. Anticancer Res. 2012 Aug;32(8):3397-401
[13] Ledermann JA, Kristeleit RS. Optimal treatment for relapsing ovarian cancer. Ann Oncol. 2010 Oct;21 Suppl 7:vii218-22. doi: 10.1093/annonc/mdq377
[14] McGill FM, Ritter DB, Rickard CS, Kaleya RN, Wadler S, Greston WM, O'Hanlan KA. Krukenberg tumors: can management be improved? Gynecol Obstet Invest. 1999;48(1):61-5. doi: 10.1159/000010136
[15] Wu XJ, Yuan P, Li ZY, Bu ZD, Zhang LH, Wu AW, Zong XL, Li SX, Shan F, Ji X, Ren H, Ji JF. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves the survival of gastric cancer patients with ovarian metastasis and peritoneal dissemination. Tumour Biol. 2013 Feb;34(1):463-9. doi: 10.1007/s13277-012-0571-4
[16] Kuijpers AM, Mehta AM, Aalbers AG, van Driel WJ, Boot H, Verwaal VJ. Treatment of ovarian metastases of colorectal and appendiceal carcinoma in the era of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol. 2014 Aug;40(8):937-42. doi: 10.1016/j.ejso.2014.02.238
[17] Aziz M, Kasi A. Cancer, krukenberg tumor. TreasureIsland (FL): StatPearls Publishing; 2020
[18] Xie H, Erickson BJ, Sheedy SP, Yin J, Hubbard JM. The diagnosis and outcome of Krukenberg tumors. J Gastrointest Oncol. 2021 Apr;12(2):226-236. doi: 10.21037/jgo-20-364