The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries

Kim, Woo Young; Kim, Tae-Joong; Kim, Sei Eun; Lee, Jeong‐Won; Lee, Je‐Ho; Kim, Byoung-Gie; Bae, Duk-Soo

doi:10.1016/j.ejogrb.2009.11.011

Cited by 54 publications

(75 citation statements)

References 20 publications

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“…In synchronous cases, ovarian metastases are detected prior to the primary tumor in 40.9-58.5% of the cases (5,14). Abdominal distention, pain or a palpable mass is the most usual clinical presentation in patients with ovarian metastases (3,6,19,20,23). It is noteworthy that abnormal uterine bleeding is not a rare presentation, even in postmenopausal women (6,19).…”

Section: Clinical Presentationsmentioning

confidence: 99%

“…In addition, ovarian metastases from gastric cancers tend to be Krukenberg tumors, with the characteristics of being bilateral rather than unilateral (3,4,6,7,14,(17)(18)(19)(20) and predominantly solid (3,21). Furthermore, it has also been reported that ovarian metastases from gastric cancer are more commonly found in premenopausal rather than in postmenopausal women (17,19,22,23).…”

Section: Characteristicsmentioning

confidence: 99%

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Metastatic gastric cancer to the female genital tract

Matsushita

Watanabe

Wakatsuki

2016

Molecular and Clinical Oncology

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Abstract. Metastases to the female genital tract from gastric cancer are rare, but they significantly worsen the prognosis of such patients. The potential routes for metastasis to the female genital tract from gastric cancer include hematogenous spread, lymphatic spread and surface implantation. The rate of lymphatic metastasis to the ovary from gastric cancer has been reported to be higher compared with that from colorectal cancer. Uterine or Fallopian tube metastases are usually secondary to ovarian metastases, which are typically identified prior to the detection of gastric cancer in half of all synchronous cases, with complaints of abdominal distention, pain, palpable mass, or abnormal uterine bleeding. The prognosis of patients with female genital tract metastases from gastric cancer is extremely poor, and is worse compared with that of other primary sites, such as the breast and colorectum. In the past, surgical intervention in such patients consisted mainly of palliative resection to relieve the symptoms associated with a sizeable pelvic mass. However, recent retrospective studies based on a relatively small number of patients have reported that surgical tumor debulking plus chemotherapy may improve the prognosis of patients with metastatic ovarian cancer originating from gastric cancer.

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Section: Clinical Presentationsmentioning

confidence: 99%

Section: Characteristicsmentioning

confidence: 99%

Metastatic gastric cancer to the female genital tract

Matsushita

Watanabe

Wakatsuki

2016

Molecular and Clinical Oncology

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“…Several studies have investigated the options of metastasectomy and cytoreductive surgery for Krukenberg tumor (13,19,20). The role of metastasectomy for Krukenberg tumor was assessed between different primary cancer types, different types of surgery or extent of residual disease.…”

Section: Univariate Analysis Multivariate Analysis ------------------mentioning

confidence: 99%

Clinical characteristics and prognostic analysis of Krukenberg tumor

Zhao

et al. 2015

Molecular and Clinical Oncology

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Abstract. Krukenberg tumor is a rare metastastic tumor of the ovary, characterized by poor prognosis. In order to analyze the clinical characteristics and prognostic factors, we retrospectively investigated 128 patients who were diagnosed with Krukenberg tumor between January, 1990 and December, 2010. The median patient age was 48 years. The median overall survival (OS) of Krukenberg tumor for all patients was 16 months (95% CI: 15-19 months). The median OS among patients with Krukenberg tumors of gastric, colorectal, breast and other origins (including appendix, gallbladder, small intestine and unknown primary) was 11, 21.5, 31 and 19.5 months, respectively (P<0.0001). In the univariate analysis, synchronous metastasis, no chemotherapy, ovarian metastasis beyond the pelvis, ascites and no metastasectomy were identified as significant poor prognostic factors. The multivariate analysis suggested that synchronous metastasis (P=0.0080), pelvic invasion (P=0.0138), ascites (P<0.0001) and no metastasectomy (P=0.0060) were independent factors for predicting unfavorable OS. It was suggested that the prognosis of Krukenberg tumor is dismal and ovarian metastasectomy may prove beneficial. Adequate treatment planning is required for this group of patients. IntroductionKrukenberg tumor is a rare metastatic signet ring cell tumor of the ovary, accounting for 1-2% of all ovarian tumors. The stomach is the primary site in the majority of Krukenberg tumor cases, followed by carcinomas of the colon, appendix and breast, particularly invasive lobular carcinoma (1). The eponym was attributed to this tumor following the description of 5 cases by Friedrich Krukenberg (1871-1946) in 1896, who described it as being common among young women, presenting with ascites, an uneven knobby ovarian surface and lymphatic involvement (2). These tumors are characterised by uncertain pathogenesis, challenging etiological diagnosis and poorer prognosis compared with their primaries. Previously, any metastatic ovarian cancer was referred to as Krukenberg tumor; however, Novak and Gray (3) created new diagnostic criteria to eliminate any confusion. Accordingly, a mucin-secreting signet ring cell carcinoma in the dense fibroblastic stroma of the ovary is referred to as Krukenberg tumor. The diagnosis of Krukenberg tumor is currently based on the diagnostic criteria of the World Health Organization based on the pathological description by Serov and Scully (4). The presence of the following characteristics is required for diagnosis: Stromal involvement, mucin-producing neoplastic signet ring cells and ovarian stromal sarcomatoid proliferation.Krukenberg tumor is considered as a late-stage disease with poor prognosis and may account for 30-40% of metastatic cancers to the ovaries (5). The treatment approach to these metastatic ovarian tumors remains controversial. To date, treatment mainly consists of ovarian metastasectomy, chemotherapy or radiotherapy; however, the optimal treatment has not yet been established. As the biological behavior and clinical...

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“…In other study [4], 76% of patients had GI primary cancer, followed by the breast (7%). However, in Korea, the primary origin was the stomach (46.2%), the colon (38.6%), the appendix (6.3%), and the breast (1.9%) [5]. This can be explained by difference in primary cancer incidences.…”

Section: Discussionmentioning

confidence: 90%

A young patient in Korea with Krukenberg tumors arising from breast cancer: A case report

Kwon

Nam

Kim

et al. 2011

Korean J Obstet Gynecol

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Metastasis of breast cancer to lung, bone and liver is common, but metastasis to ovaries is rare in Korea. A 31-year-old woman diagnosed with breast cancer was referred to our department due to a newly detected adnexal mass via abdomen sonography during regular check-up. Imaging studies revealed solid mass on left ovary and enlarged lymph nodes. She underwent a laparotomy including hysterectomy, bilateral salpingo-oophorectomy, lymphadenectomy, with a suspected impression of primary ovarian neoplasms or Krukenberg tumors. Pathologic fi ndings revealed metastatic adenocarcinoma from breast cancer involving left ovary and paraaortic lymph nodes. To our knowledge, this is the youngest Korean patient with Krukenberg tumors from the breast. In Korea, since the average age affected by breast cancer is younger than in the West, and the incidence and the mortality of breast cancer has increased, possible ovarian metastasis should be kept in mind when Korean patient with breast cancer visits for follow-up. Krukenberg tumors, which refer to metastatic ovarian tumors originating from various sites, account for about 0.7-6.7% of ovarian tumors and 10-30% of malignant ovarian tumors [1,2]. The primary origin sites are usually the gastrointestinal (GI) tract, including the stomach and colon, the gall bladder/biliary tract, breast and others. In both Asia and the West, most metastatic ovarian tumors originate from the GI tract; others origin show different proportions because of the incidence and commonly affected ages of primary cancer. Ovarian metastasis from breast cancer is not frequent in Asia and breast cancer in Asian women occurs at a younger age between 30 and 40 with locally-advanced stage III disease, unlike the West where women typically present after age 50 with early stage disease. Here we present the case of the youngest patient in Korea with Krukenberg tumors arising from breast cancer. Case ReportA 31-year-old married female (gravida 2, para 2) was diagnosed with left breast cancer involving axillary lymph nodes metastasis CASE REPORT Korean J Obstet Gynecol 2011;54(10):643-646 http://dx

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The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries

Cited by 54 publications

References 20 publications

Metastatic gastric cancer to the female genital tract

Metastatic gastric cancer to the female genital tract

Clinical characteristics and prognostic analysis of Krukenberg tumor

A young patient in Korea with Krukenberg tumors arising from breast cancer: A case report

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