Metastatic Tumor to the Ovary
Synonyms/Description
Secondary ovarian tumor
Krukenberg tumor (originating mostly from the gastrointestinal tract)
Etiology
Metastatic tumors to the ovary account for approximately 20% of ovarian malignancies. The most common primary origins for metastatic disease to the ovary include colon, stomach, breast, and the genitourinary tract, and less commonly, lymphoma and leukemia. Krukenberg tumor is a specific term, characteristically used to describe metastatic colon or stomach adenocarcinoma to the ovary, although breast and other sites may be the primary. Spread of the primary tumor to the ovaries may occur from direct seeding or, more likely, via lymphatics.
Ultrasound Findings
Metastases to the ovaries are bilateral in 60% to 80% of cases, especially when the primary malignancy originates from the stomach, colon, rectum, or breast.
Krukenberg tumors are bilateral in more than 70% of cases. They are typically large masses containing solid and cystic components. Frequently the mass is multiloculated with a multitude of small cystic compartments intermixed with solid areas, giving a frothy sonographic appearance. More than 50% of Krukenberg tumors have associated ascites, especially when there is bilateral disease. It is not uncommon to have the Krukenberg tumor be the initial symptom or finding, while the primary has not yet been discovered. Reportedly, up to 7% of ovarian lesions presenting as primary ovarian malignancies are actually metastatic in origin.
Metastatic tumors from nongastrointestinal origin tend to be more solid and smaller than those from a gastrointestinal origin.
Differential Diagnosis
Metastatic tumors to the ovary can have a similar appearance to primary ovarian malignancies. Both can be complex cystic and solid masses associated with ascites. The bubbly or frothy appearance of the mass, often large and bilateral, is a feature that should raise suspicion for metastatic adenocarcinoma of the gastrointestinal tract rather than a primary ovarian cancer.
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