Colour Doppler imaging and computed tomographic findings in Krukenberg's tumour

Transvaginal ultrasound evaluation revealed bilateral ovarian mass lesions. The lesions were solid and isoechoic relative to uterus (Fig. 1). On colour Doppler imaging, the lesions showed rich vascular signals, most prominent in the peripheral portion of the lesion (Fig. 2a). Spectral analysis showed both venous and arterial waveforms within the lesion. Arterial signals showed decreased resistive index due to increased diastolic flow (Fig. 2b). The patient was referred for abdominal computed tomographic (CT) evaluation.

On CT sections through the upper abdomen, mural thickening was detected together with a mass lesion protruding into the lumen at the gastric antrum (Fig. 3a). On lower sections, bilateral ovarian enlargement was detected. The ovaries were solid and there was marked contrast enhancement (Fig. 3b). A diagnosis of gastric carcinoma was confirmed by endoscopic and histopathological examination.

Histopathological evaluation of the ovaries after surgery showed bilateral Krukenberg's tumours.

The differential diagnosis from a primary ovarian tumour is very important for therapeutic approach. Krukenberg's tumours are bilateral in 60-80% of cases. Therefore whenever bilateral ovarian involvement is detected, a search for a primary site, especially in the gastrointestinal system, should be carried out. In contrast to primary ovarian tumours, the ovaries keep their shape in Krukenberg's tumour.

Some other radiological findings give important clues. Early in the development of these tumours, the solid component is most prominent, as seen in this case. At US Krukenberg tumor typically present as bilateral, solid ovarian masses, with clear well defined margins. An irregular hyperechoic solid pattern and moth eaten like cyst formation are also characteristic, allowing with some confidence to distinguish these lesions from primary ovarian neoplasms. A relatively prominent vascular signal along the wall of the intramural cysts in a predominantly solid ovarian mass has also been described as a suggestive finding. In the early stages, these tumours are easy to differentiate from primary ovary tumours, but in the late stages, it may be difficult to differentiate from primary ovarian mucinous carcinomas. In the late stages, the demonstration of highly vascular bilateral mass lesions can suggest the possibility of Krugenberg's tumour.