Ovarian metastasis is not a rare condition and occurs secondary to malignancies originating from the stomach, colon, breast, endometrium, fallopian tubes, or cervix. Clinical manifestations are due to the primary tumor as well as due to the metastases. Diagnosis depends on imaging studies and can only be confirmed with a histopathological examination of the ovarian tissue specimen.
Ovarian metastasis accounts for up to 30% of all ovarian malignancies. The term "Krukenberg tumor" is used in practice to include all metastatic ovarian tumors although only 40% of ovarian metastases are due to Krukenberg tumor which is a signet cell gastrointestinal malignancy . Cancerous tumors from several organ systems, such as gastrointestinal and female genital tract, could spread to the ovaries . Of these, the commonest are from the breast, colon, and stomach . Lymphatic spread of tumor is faster and more common from the stomach to the ovaries than from the colon while the vascular spread is higher from the colon than from the stomach .
A majority of patients with ovarian metastases may be asymptomatic. When they present with symptoms, either the primary malignancy may be diagnosed concomitantly or may have been identified earlier  . In addition to clinical manifestations of the primary malignancy, patients may complain of abdominal pain, swelling , bloating, and increase in abdominal girth (due to ascites) . Hypertrophy of the ovarian tissue may result in endocrine manifestations such as virilization . Common symptoms and signs of a malignancy such as weight loss, anorexia, easy fatiguability, asthenia, nausea, vomiting, and diarrhea may also be present. In addition, patients may complain of dysuria, increased frequency of micturition, and constipation due to compression of neighboring organs by the enlarged ovaries. Lower limb deep vein thrombosis and paraneoplastic syndromes are some of the other manifestations in individuals with ovarian metastases.
Krukenberg tumors are associated with bilateral, asymmetrical enlargement of the ovaries without peritoneal adhesions and deposits while metastases from other tumors are embedded within the ovarian capsule or in the peritoneum .
Entire Body System
- Abdominal Pain
After receiving a 6 course first line chemotherapy and 8 course maintenance therapy, the patient suffered acute abdominal pain, so surgery was performed. [ncbi.nlm.nih.gov]
Most common symptom was abdominal pain ( n 11; 55). Carcinoembryonic antigen was elevated in 17 (85%) patients and CA-125 in 15 (75%) patients. Involvement of ovary was bilateral in almost half of the patients ( n 11; 55%). [ccij-online.org]
In addition to clinical manifestations of the primary malignancy, patients may complain of abdominal pain, swelling, bloating, and increase in abdominal girth (due to ascites). [symptoma.com]
Clinical description Malignant SCST of ovary may occur at any age but usually occurs in child bearing or post menopausal age groups, presenting with manifestations of mass effect (abdominal pain or distention, gastrointestinal symptoms, or abdominal mass [orpha.net]
- Pelvic Mass
A 5-year-old girl with stage M neuroblastoma presented with an upper abdominal and a pelvic mass. Evaluation after induction showed very good tumour response with three remaining localisations: two abdominal and one pelvic. [ncbi.nlm.nih.gov]
- Pelvic Pain
Abdominal or pelvic pain, abdominal bloating, or pain during intercourse, may be the presenting symptom. Irregular bleeding may also be seen. Median patient age at presentation is 48 years. [radiopaedia.org]
pain, bloating, ascites, or pain during sexual intercourse. [en.wikipedia.org]
In such cases, the signs and symptoms associated with the accompanying syndrome may exist Following are the common signs and symptoms associated with this tumor type: Abdominal pain (the pain is usually a pelvic pain) Abdominal swelling due to the mass [dovemed.com]
We repot the case of a 36-year-old woman who was admitted in our hospital with pelvic pain and ascites and also with suspicion of peritoneal carcinomatosis. [medichub.ro]
The first case of EOPPC was reported by Swerdlow in 1959. He described a 27-year-old woman experiencing pelvic pain, who, upon examination, was found to have an adnexal mass. [cancernetwork.com]
In May 2001, the patient was hospitalized with a three-month history of progressive vaginal bleeding and lower-abdominal discomfort with urinary incontinence. [academic.oup.com]
A working diagnosis of ovarian metastasis is made on clinical suspicion and physical examination findings while confirmation requires histological examination of either ovarian tissue or ascitic fluid. So the workup consists of a detailed history, thorough physical examination, laboratory tests, imaging studies, and pathohistological examination. History may or may not elicit clinical manifestations of a concurrent primary tumor.
Urinalysis is performed to rule out renal causes of symptoms. Tumor markers like beta-human chorionic gonadotropin, alpha-fetoprotein, lactate dehydrogenase, and cancer antigen-125 (CA 125) are not diagnostic . Imaging studies include abdominal and pelvic ultrasonography or computed tomography (CT) along with chest X-ray to exclude pulmonary metastases and mammography to rule out breast malignancy  . Positron emission tomography (PET) is indicated either to look for primary tumors or confirm the presence of metastatic lesions . Magnetic resonance imaging (MRI) may be considered, although it is not confirmatory .
Histopathology of ovarian tissue or ascitic fluid and immunohistochemistry is required to confirm the diagnosis . Microscopically, signet ring cells filled with mucin are characteristic of Krukenberg tumors and the cells are immunoreactive to epithelial markers such as epithelial membrane antigen and cytokeratins but nonreactive to vimentin and inhibin  .
- Ovarian Mass
After three treatments, a check-up with computed tomography demonstrated the presence of a right ovarian mass. An ovariectomy was performed, and the pathological examination confirmed the diagnosis of an ovarian metastasis from an ocular melanoma. [ncbi.nlm.nih.gov]
Case We report the case of a 51 years old woman, treated 9 years before for papillary thyroid carcinoma, presenting to our Institute with a pelvic ovarian mass revealed by ultrasound imaging. [diagnosticpathology.biomedcentral.com]
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