69 - Case Report: Anatomical Study of Krukenberg Tumor in a Cadaver Reveals Clinical and Pathologic Correlates

Poster Board Number: 69
There are separate poster presentation times for odd and even posters.
Odd poster #s – first hour
Even poster #s – second hour

Co-authors:

Kristen Mathew - Georgetown University School of Medicine; John Anderson - Georgetown University School of Medicine; Zhi Li - Georgetown University School of Medicine; Kitara Smith, M.S. - Georgetown University School of Medicine; Pichayut Nithagon, M.D. - Department of Pathology - MedStar Georgetown University Hospital; Caitlin Coker, Ph.D. - Georgetown University School of Medicine

Abstract Body : Krukenberg tumors are rare metastatic tumors of the ovary defined by the presence of signet ring cells microscopically. These tumors metastasize from a primary diffuse adenocarcinoma of the stomach in 70% of cases and involve both ovaries in 80% of cases. The average tumor diameter in the ovaries is about 10 cm. During a routine educational cadaveric dissection of the abdomen in a 69-year-old female, a large, right ovarian mass (14.8 cm x 11.1 cm x 11.0 cm) was identified and confirmed to be a Krukenberg tumor. The objective of this study was to evaluate the impact of the Krukenberg tumor on the underlying anatomy of the abdomen and pelvis in order to identify relevant clinical and pathologic correlates. Primary inspection of the abdomen revealed significant shifting of the intestinal contents superiorly, and subsequent dissection revealed a dilated right ureter and renal pelvis due to distal compression by the tumor. Consistent with the gastric cancer subtype, linitis plastica, the stomach had a “leather bottle” appearance with thickened surrounding musculature. A central band of fibrosis was identified that gave the stomach a unique bilobed appearance, and an enlarged lymph node was identified on its posterior aspect. Review of hematoxylin and eosin stained samples from both ovaries and the stomach wall revealed infiltrating, malignant cells with signet-ring morphology and intracellular mucin. The identified abnormalities in the abdomen and pelvis caused by the sheer size of this tumor provide an anatomical basis for the clinical symptoms experienced by patients with Krukenberg tumors (ascites, abdominal pain, increased risk of intestinal obstruction, and increased risk of hydronephrosis). The gross anatomic changes to the stomach can provide insights into the pathophysiology of diffuse adenocarcinoma of the stomach.