EMERGENCY SURGICAL TREATMENT OF GIANT BILATERAL METACHRONUS KRUKENBERG TUMORS OF SIGMOID ORIGIN: A CASE REPORT

Abstract

Krukenberg tumors are metastatic malignancies of the ovaries that consist of mucin-rich signet-ring adenocarcinomas. The stomach is the primary site in most cases (70%), while carcinomas of the colon, appendix and breast (mostly invasive lobular carcinomas) are the next most common sites. We present the case of a 56-year-old female with a history of a stage IV M1 hep sigmoid adenocarcinoma who underwent neoadjuvant chemotherapy. During this time a tumoral mass in the lower abdomen kept developing and growing bigger and bigger, causing subocclusive symptoms by external compression, such as intermittent constipation, cramping pains with lack of flatus and episodes of vomiting. A CT scan of the abdomen was performed, which showed a uterus of large dimensions, a myometrium of inhomogeneous structure with multiple nodules that could not be separated from the adnexal masses and tumoral masses in both ovaries with important growth in dimensions, currently measuring 16/12/15 cm (trans/a-p/c-c) for the right ovary and 14/12/11 (trans/a-p/c-c) cm for the left ovary, in contact with each other cranially and extended up to the subhepatic land mesogastrium level. A total hysterectomy with bilateral anexectomy was performed, in order to improve patient’s condition and to help her continue her chemotherapy. The postoperative recovery went smooth, the patient resumed her transit 6 days after the intervention. Krukenberg tumors are rare ovarian metastatic tumors, that can be more aggressive than the primary tumor itself and can even endanger patient’s life due to their acute symptoms, for which they may require per primam surgical intervention before tackling the primary tumor.