Incidental diagnosis of torsion of a Krukenberg tumor originating from sigmoid colon cancer

Explanation image

A Krukenberg tumor refers to gastrointestinal cancer that metastasizes to the ovaries; this tumor was named after Krukenberg, who originally described this pathologic condition of the ovaries in 1896. The prognosis of this tumor is uniformly poor [1]. In the malignant state, the torsion of ovarian tumor is a rare condition because of the adhesions associated with malignant lesions. Two cases of torsion of Krukenberg tumors have been reported so far [2, 3].

A 46-year-old woman presented to the emergency department with abdominal pain. Abdominopelvic computed tomography showed a multicystic lesion with a diameter of 6.6 cm in the right ovary (Fig. 1). Pelviscopy showed a right ovarian mass that had twisted three times in a counterclockwise direction (Fig. 2). Right salpingo-oophorectomy was performed under pelviscopy. Strangely, however, the excised ovarian tissue was friable like caseous necrosis. After the right salpingo-oophorectomy was completed, the surgical specimen was sent to the department of pathology for obtaining a frozen section. Frozen-section analysis led to the diagnosis of adenocarcinoma; we performed exploratory laparotomy. Moreover, total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy, pelvic lymph node dissection, and low anterior resection of the colon were performed. The tumor was pathologically diagnosed as a metastatic adenocarcinoma of the colon. The patient was transferred to the department of oncology, and adjuvant chemotherapy (FOLFIIR#15) was administered.

Fig. 1

The coronal section of abdominopelvic computed tomography showed a right adnexal mass with torsion (arrow)

Fig. 2

Laparoscopy of the right ovarian cyst showed that the adnexal pedicle had twisted three times in a counterclockwise direction