Krukenberg tumor in a pregnant patient with severe preeclampsia

Abstract

Krukenberg tumors accompanied by gestational hypertension are rare and have a poor patient prognosis. A gravida 1, para 0 patient was submitted to Tianjin Medical University General Hospital (Tianjin, China) at 32 weeks gestation with symptoms of nausea, vomiting and hypertension. Diagnosis from the gastroscopic biopsy was of a gastric ulcer. A unilateral ovarian mass was identified with B-scan ultrasonography and magnetic resonance imaging, but was confirmed pathologically as a bilateral Krukenberg tumor. Positron emission tomography-computed tomography revealed a high radioactive uptake in the lesser curvature wall of the stomach, and postoperative pathology revealed poorly differentiated adenocarcinoma of the stomach. As Krukenberg tumors are difficult to diagnose, exhibit fast progression and have a poor clinical outcome, developing a greater understanding of Krukenberg tumors is crucial. Imaging manifestations combined with serological examination may aid in early detection, which may lead to improved patient management.

Krukenberg Progression of Gastric Carcinoma in Pregnancy: Is Early Diagnosis Possible? Case Report and Review of the Literature

“…Krukenberg tumors are an extremely rare complication in pregnancy, associated with a poor outcome [ 3 ]. A review conducted in 2016 showed a median survival time of six months in this patient collective [ 7 ].…”

“…However, initial misdiagnosis based on imaging techniques appears to be a common problem often described in the literature. Reported differential diagnoses include epithelial ovarian cancer [ 3 ], benign tumors [ 11 ], Meigs’ syndrome [ 12 ], or luteoma [ 13 ]. The main concern is that this often leads to a delay in treatment since surgical resection of a suspected benign tumor in pregnancy is often postponed to avoid unnecessary pre-term birth.…”

“…In the literature, widely different approaches regarding further diagnostic measures have been described. There are cases where no further evaluation was conducted due to missing consequences in the palliative setting as well as due to the patient’s wishes [ 11 ], while the entire possible diagnostic work-up, including full endoscopy and multiple imaging techniques such as positron emission tomography, was utilized in other cases [ 3 ].…”

“…The most common type are epithelial tumors [ 2 ]. Krukenberg tumors in pregnancy are rare and are associated with a poor outcome [ 3 ].…”

Krukenberg Tumor of Gastric Origin in Pregnant Women with Preeclampsia

“…Unlike hirsutism, virilization, or ascites, pregnancy with a Krukenberg tumor complicated with PE is rare. A literature search was conducted on PubMed up to April 2022, selecting the most relevant studies on the basis of the scope of the review, and to our knowledge, only 7 cases with full English texts have been published to date; see Table 1 [8][9][10][11][12]. In healthy humans, vascular endothelial growth factor (VEGF) promotes angiogenesis in embryonic development and is important in wound healing in adults.…”