PURPOSE: This study was conducted to validate the survival benefit of metastasectomy plus chemotherapy over chemotherapy alone for treatment of Krukenberg tumors from gastric cancer and to identify prognostic factors for survival. MATERIALS AND METHODS: Clinical data from 216 patients with Krukenberg tumors from gastric cancer were collected. Patients were divided into two arms according to treatment modality: arm A, metastasectomy plus chemotherapy and arm B, chemotherapy alone. RESULTS: Overall survival (OS) was significantly increased in arm A relative to arm B for patients initially diagnosed with stage IV gastric cancer (18.0 months vs. 8.0 months; p < 0.001) and those with recurrent Krukenberg tumors (19.0 months vs. 9.0 months; p=0.002), respectively. Metastasectomy (hazard ratio [HR], 0.458; 95% confidence interval [CI], 0.287 to 0.732; p=0.001), signet-ring cell pathology (HR, 1.583; 95% CI, 1.057 to 2.371; p=0.026), and peritoneal carcinomatosis (HR, 3.081; 95% CI, 1.610 to 5.895; p=0.001) were significant prognostic factors for survival. CONCLUSION: Metastasectomy plus chemotherapy offers superior OS when compared to palliative chemotherapy alone in gastric cancer with Krukenberg tumor. Prolonged survival applies to all patients, regardless of gastric cancer stage. Metastasectomy, signet-ring cell pathology, and peritoneal carcinomatosis were prognostic factors for survival. Future prospective randomized trials are needed to confirm the optimal treatment strategy for Krukenberg tumors from gastric cancer.
Arm ; Carcinoma ; Drug Therapy* ; Humans ; Krukenberg Tumor* ; Metastasectomy ; Pathology ; Prognosis ; Prospective Studies ; Stomach Neoplasms*

PURPOSE: The purpose of this study was to correlate CT and pathologic findings of metastatic ovarian tumors, with an emphasis on intratumoral low density area. MATERIALS AND METHODS: Twenty three metastatic ovarian tumorsin 18 patients were included in this study. The primary sites were the stomach in all the Krukenberg tumorgroup(n=10), and the colon (n=6), stomach (n=1), unknown primary site (n=1) in the non-Krukenberg group (n = 8). Low density areas which were lower than back muscle density in post enhanced CT scan were divided into twosubgroups : well-defined and ill-defined. The well-defined low density areas were subdivided into two types, round and amorphous. RESULTS: Well-defined low density areas on CT (n=18) corresponded on histopathological examinationto cystic degeneration(n=2), dysfunctional cysts(n=7), cystic degeneration with dysfunctional cysts (n=3), and dilated mucin producing glands(n=6). All the cystic degeneration and dysfunctional cysts, which were seen in 10 of12 (83 %) Krukenberg tumors, were round in appearance. Dilated mucin-producing glands(n=6), which were seen onlyin non-Krukenberg tumors, were amorphous(n=4), or round(n=2) in shape. Enhancement of the wall of well-defined low density areas(n=8) was demonstrated only in Krukenberg tumors (n=8). Ill-defined low density areas(n=16) corresponded to myxoid degeneration(n=10) in Krukenberg tumors, and necrosis(n=6) in non-Krukenberg tumors. CONCLUSION: The presence of a round well-defined intratumoral low density area, or wall enhancement, which corresponds to cystic degeneration or dysfunctional cyst on pathology, may suggest a Krukenberg tumor in thestomach, while an amorphous well-defined low density area, which corresponds to dilated mucin producing glands, issuggestive of a non-Krukenberg tumor in extragastric organs.
Back Muscles ; Colon ; Humans ; Krukenberg Tumor ; Mucins ; Pathology ; Stomach ; Tomography, X-Ray Computed

Carcinoma of the ampulla of Vater is a relatively rare neoplasm and its longterm survival rate is considerably high. However, because of differences in tumor pathologic features and local invasiveness, a 5-year survival rate differ widely. We present a case of metastatic carcinoma of the ampulla of Vater presenting as a Krukenberg tumor in a 59-year-old woman. Eight months earlier, she had been diagnosed as well-differentiated adenocarcinoma of the ampulla of Vater. Abdominal examination revealed a hard mass with mild tenderness in the RLQ area. The laboratory findings were unremarkable except for mild anemia. CT scan of the abdomen revealed enlargement of both ovaries. An exploratory laparotomy disclosed bilateral ovarian masses, 18 x 12 x 8 cm and 8 x 5.5 x 4 cm in size, respectively. Histologic findings of the both ovarian masses were consistent with metastatic adenocarcinoma from the ampulla of Vater.
Case Report ; Common Bile Duct Neoplasms/surgery ; Common Bile Duct Neoplasms/pathology* ; Female ; Human ; Krukenberg Tumor/secretion* ; Krukenberg Tumor/pathology ; Middle Age ; Ovarian Neoplasms/secondary* ; Tomography, X-Ray Computed ; Vater's Ampulla*/pathology

PURPOSE: The relative ftequency of ovarian metastases from various organs reported in literature varies with geographic distribution. To our knowledge, there has been no comprehensive report on the subject of metastatic cancer to the ovary in Korea, so we tried to evaluate the clinical characteristics of them. MATERIALS AND METHODS: We reviewed the files of the Department of Pathology from January 1988 to December 1997 in Seoul National University Hospital and obtained 38 cases diagnosed as metastatic cancer to ovary. We retrospectively reviewed the patients' records and evaluated the clinical characteristics, treatment modalities and clinical outcome. RESULTS: The mean age of patients was 43.7 years (range: 19-63) and the most common symptom was pelvic pain (21.1%). The origins of primary cancer were as follows in the order of frequency: stomach (65.8%), colon (13.2%), unknown (10.5%), hematologic malignancy (7.9%) and lung (2.6%). The most common pathologic findings were metastatic adenocarcinoma in 34 cases (89.5%), among which 14 cases (36.8%, 14/38) were Krukenberg tumor. The origins of primary cancer were diagnosed preoperatively in only 18 cases (47.4%). Eleven patients (28.9%) received surgery only, while 27 patients (71.1%) received both surgery and adjuvant chemotheiapy. For all patients, the median survival was 17 (range: 11-23) months and the overall 3-year survival rate (3YSR) was 28.6%. There were no significant differences in 3YSR according to primary tumor sites, status of ovarian involvement, pathologic finding, diagnostic time and treatment modalities. CONCLUSION: Although the overall survival rate and clinical factors which might affect survival were similar to previous reports from Westem countries, the most common origin of primary cancer was different.
Adenocarcinoma ; Colon ; Female ; Hematologic Neoplasms ; Humans ; Korea ; Krukenberg Tumor ; Lung ; Neoplasm Metastasis ; Ovarian Neoplasms* ; Ovary ; Pathology ; Pelvic Pain ; Retrospective Studies ; Seoul ; Stomach ; Survival Rate

OBJECTIVETo compare the clinicopathological characters and operative prognosis of gastric cancer complicated with Krukenberg tumor and with pelvic peritoneal dissemination.

METHODSThirty-nine female cases of gastric carcinoma with pelvic metastasis were treated operated on between August 1994 and March 2006. Among them, 18 cases were complicated with Krukenberg tumor and 21 cases with pelvic peritoneal dissemination. The clinicopathological characters in the two groups were recorded and compared and the operative prognosis were analyzed.

RESULTSThere was no significant difference in age, tumor location and size, hepatic metastasis, organic encroachment, infiltration degree, positive lymph nodes, differentiated degree, tissue typing, Borrmann typing, value of carcinoembryonic antigen between the two groups (P > 0.05). The rate of P3 (peritoneal dissemination) in the cases of Krukenberg tumor (44.4%) was significantly lower than that in pelvic peritoneal dissemination group (85.7%) (P < 0.01), whereas the focal resection rate (77.8%) and multi-organ dissection rate (55.6%) were significantly higher than in pelvic peritoneal dissemination (38.0%, 23.8%) (P < 0.05). The mean survival of all cases was 12.6 months. The mean survival in the patients with Krukenberg tumor and pelvic peritoneal dissemination was 20.5, 15.0 months, respectively (P < 0.05). The mean survival of total focal resection, palliative focal resection, non-focal resection was 19.9, 12.5 and 5.7 months, respectively (P < 0.01). Non-focal resection, pelvic peritoneal dissemination, P3 of peritoneal implantation, hepatic metastasis, organic encroachment, total gastric cancer were unfavorable prognosis factors for all cases.

CONCLUSIONSCompared with pelvic peritoneal dissemination, the gastric cancer with Krukenberg tumor is associated with more limited peritoneal dissemination, higher resection rate and better prognosis. Focal resection can improve the prognosis.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Krukenberg Tumor ; pathology ; surgery ; Middle Aged ; Neoplasm Seeding ; Pelvic Neoplasms ; pathology ; secretion ; surgery ; Peritoneal Neoplasms ; pathology ; secondary ; surgery ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

Aged ; Biomarkers ; metabolism ; Carcinoid Tumor ; metabolism ; pathology ; Carcinoma, Endometrioid ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Granular Cell Tumor ; metabolism ; pathology ; Humans ; Hysterectomy ; methods ; Keratin-7 ; metabolism ; Keratins ; metabolism ; Krukenberg Tumor ; metabolism ; pathology ; Middle Aged ; Mucin-1 ; metabolism ; Ovarian Neoplasms ; metabolism ; pathology ; surgery ; Sertoli Cell Tumor ; metabolism ; pathology ; Sex Cord-Gonadal Stromal Tumors ; metabolism ; pathology ; surgery