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Feto-maternal outcomes of pregnancy complicated by Krukenberg tumor: a systematic review of literature

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Krukenberg tumor is a rare type of ovarian cancer with a poor prognosis, and little is known about its behavior during pregnancy.

Methods

A systematic review was conducted to identify pregnancies complicated by Krukenberg tumor, correlated to oncologic and neonatal outcomes (n = 35).

Results

Mean age of cases was 30.4 years, and the most common origin of primary cancer was the stomach (68.6 %) followed by the colon (14.3 %). The two most common presenting symptoms were abdominal/pelvic pain (51.4 %) and nausea/vomiting (48.6 %). Two-thirds of tumors were bilateral (65.7 %) and the average size was 16.7 cm. Ascites (45.7 %), carcinomatosis (25.7 %) and non-ovarian distant metastases (14.3 %) were found at the time of surgery. Chemotherapy was administered in 20 cases, with fetal exposure in two of these. The ovarian tumor was identified prior to the primary cancer diagnosis in all 28 cases. The overall number of live births was 27 (81.8 %). The median survival was 6 months after Krukenberg tumor diagnosis. In univariate analysis, decreased overall survival was associated with dyspnea, ascites, carcinomatosis, non-radical surgery for the primary cancer, and residual disease at surgery (all, p < 0.05). On multivariate analysis, dyspnea and carcinomatosis remained independent prognostic factors for decreased overall survival after Krukenberg tumor diagnosis (2-year overall survival rates, dyspnea 0 vs. 56.6 %, adjusted-hazard ratio [HR] 9.74, 95 % confidence interval [CI] 2.04–46.2, p < 0.01; and carcinomatosis, 0 vs. 58.1 %, adjusted-HR 7.95, 95 % CI 1.76–36.0, p < 0.01).

Conclusions

Our results showed that prognosis of Krukenberg tumor complicated pregnancies is extremely poor, however it may be improved if radical surgery is achievable.

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References

  1. Gezginc K et al (2011) Ovarian cancer during pregnancy. Int J Gynaecol Obstet 115:140–143

    Article  PubMed  Google Scholar 

  2. Machado F et al (2007) Ovarian cancer during pregnancy: analysis of 15 cases. Gynecol Oncol 105:446–450

    Article  PubMed  Google Scholar 

  3. Blake EA et al (2015) Feto-maternal outcomes of pregnancy complicated by epithelial ovarian cancer: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol 186:97–105

    Article  PubMed  Google Scholar 

  4. Kodama M et al (2014) Feto-maternal outcomes of pregnancy complicated by ovarian malignant germ cell tumor: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol 181:145–156

    Article  PubMed  Google Scholar 

  5. Blake EA et al (2014) Feto-maternal outcomes of pregnancy complicated by ovarian sex-cord stromal tumor: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol 175:1–7

    Article  PubMed  Google Scholar 

  6. Woodruff JD, Novak ER (1960) The Krukenberg tumor: study of 48 cases from the ovarian tumor registry. Obstet Gynecol 15:351–360

    CAS  PubMed  Google Scholar 

  7. Kiyokawa T, Young RH, Scully RE (2006) Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol 30:277–299

    Article  PubMed  Google Scholar 

  8. Duenas-Garcia OF, Diaz-Sotomayor M, Chanana C (2011) Bilateral ovarian krukenberg tumor in a full-term pregnancy. ISRN Obstet Gynecol 2011:620380

    PubMed  Google Scholar 

  9. Co PV et al (2014) Gastric cancer presenting as a krukenberg tumor at 22 weeks’ gestation. J Gastric Cancer 14:275–278

    Article  PubMed  PubMed Central  Google Scholar 

  10. Stojnic J et al (2011) Krukenberg tumor of gastric origin in pregnancy with dismal outcome. Eur J Gynaecol Oncol 32:356–358

    CAS  PubMed  Google Scholar 

  11. Sandmeier D et al (2000) Bilateral Krukenberg tumor of the ovary during pregnancy. Eur J Gynaecol Oncol 21:58–60

    CAS  PubMed  Google Scholar 

  12. Ozdegirmenci O et al (2007) Krukenberg tumor mimicking pregnancy luteoma. Gynecol Endocrinol 23:482–485

    Article  PubMed  Google Scholar 

  13. Vauthier-Brouzes D et al (1997) Krukenberg tumor during pregnancy with maternal and fetal virilization: a difficult diagnosis. A case report. J Gynecol Obstet Biol Reprod (Paris) 26:831–833

    CAS  Google Scholar 

  14. Kim SH et al (2014) Disseminated cancer in pregnancy: Krukenberg tumour. Case Rep Obstet Gynecol 2014:216969

    PubMed  PubMed Central  Google Scholar 

  15. Kwon YS et al (2010) Ovarian cancer during pregnancy: clinical and pregnancy outcome. J Korean Med Sci 25:230–234

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ivanov S (2012) Pregnancy and oncological diseases. Akush Ginekol (Sofiia) 51:27–33

    CAS  Google Scholar 

  17. Takushi M et al (2002) Management of invasive carcinoma of the uterine cervix associated with pregnancy: outcome of intentional delay in treatment. Gynecol Oncol 87:185–189

    Article  PubMed  Google Scholar 

  18. Guo Q et al (2012) Management of invasive cervical cancer in pregnancy: clinical analysis of 13 cases. Zhonghua Fu Chan Ke Za Zhi 47:893–897

    PubMed  Google Scholar 

  19. Al-Agha OM, Nicastri AD (2006) An in-depth look at Krukenberg tumor: an overview. Arch Pathol Lab Med 130:1725–1730

    PubMed  Google Scholar 

  20. Stroup DF et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012

    Article  CAS  PubMed  Google Scholar 

  21. Matsuo K et al (2014) Feto-maternal outcome of pregnancy complicated by vulvar cancer: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol 179:216–223

    Article  PubMed  Google Scholar 

  22. Hadlock FP et al (1985) Estimation of fetal weight with the use of head, body, and femur measurements—a prospective study. Am J Obstet Gynecol 151:333–337

    Article  CAS  PubMed  Google Scholar 

  23. Alwyn JE, Zacharin RF (1963) Pregnancy complicated by torsion of a unilateral Krukenberg tumour. Aust N Z J Obstet Gynaecol 3:125–128

    Article  CAS  PubMed  Google Scholar 

  24. Bullon A et al (1981) Tubular Krukenberg tumor. A problem in histopathologic diagnosis. Am J Surg Pathol 5:225–232

    Article  PubMed  Google Scholar 

  25. Burgazli KM et al (2013) Discovery of asymptomatic Krukenberg tumors diagnosed during caesarean section: therapy with hyperthermic intraperitoneal chemotherapy. Postgrad Med 125:87–90

    Article  PubMed  Google Scholar 

  26. Cheng CY et al (1994) Krukenberg tumor in pregnancy with delivery of a normal baby: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 54:424–427

    CAS  Google Scholar 

  27. Chou MM et al (1998) Color Doppler sonographic appearance of a Krukenberg tumor in pregnancy. Ultrasound Obstet Gynecol 11:459–460

    Article  CAS  PubMed  Google Scholar 

  28. de Palma P et al (1995) Krukenberg tumor in pregnancy with virilization. A case report. Eur J Gynaecol Oncol 16:59–64

    PubMed  Google Scholar 

  29. El-Ghobashy A et al (2009) Recurrent urachal mucinous adenocarcinoma presenting as bilateral ovarian tumors on cesarean delivery. Int J Gynecol Cancer 19:1539–1541

    Article  PubMed  Google Scholar 

  30. Fox LP, Stamm WJ (1965) Krukenberg tumor complicating pregnancy; report of a case with androgenic activity. Am J Obstet Gynecol 92:702–710

    Article  CAS  PubMed  Google Scholar 

  31. Genc M et al (2014) Bilateral Krukenberg tumor in a 16-week pregnant woman. Eur J Gynaecol Oncol 35:95–96

    CAS  PubMed  Google Scholar 

  32. Glisic A, Atanackovic J (2006) Krukenberg tumor in pregnancy. The lethal outcome. Pathol Oncol Res 12:108–110

    Article  PubMed  Google Scholar 

  33. Hill JA, Kassam SH, Talledo OE (1984) Colonic cancer in pregnancy. South Med J 77:375–378

    Article  CAS  PubMed  Google Scholar 

  34. Johnston GA, Clausen K (1982) Early-stage carcinoma of the cervix complicating pregnancy with metastasis to an ovarian endometrioma. A case report. J Reprod Med 27:371–372

    PubMed  Google Scholar 

  35. Klein MD, Goodfriend MJ, Gordimer H (1955) Adenocarcinoma of the colon with bilateral ovarian metastases; report of a case during pregnancy. Obstet Gynecol 6:410–415

    CAS  PubMed  Google Scholar 

  36. Mackey JR, Hugh J, Smylie M (1996) Krukenberg tumor complicated by pregnancy. Gynecol Oncol 61:153–155

    Article  CAS  PubMed  Google Scholar 

  37. Okutomi T et al (2002) Intrathecal fentanyl/meperidine combined with low-dose epidural bupivacaine for Cesarean section in a patient with advanced Krukenberg tumors. Acta Anaesthesiol Scand 46:1272–1275

    Article  CAS  PubMed  Google Scholar 

  38. Orr JW, Grizzle WE, Huddleston JF (1982) Squamous cell carcinoma metastatic to placenta and ovary. Obstet Gynecol 59:81S–83S

    PubMed  Google Scholar 

  39. Papakonstantinou E et al (2011) Virilizing ovarian Krukenberg tumor in a 27-year-old pregnant woman. A case report and literature review. Eur J Gynaecol Oncol 32:331–333

    CAS  PubMed  Google Scholar 

  40. Parry-Jones E (1956) Krukenberg tumour complicating pregnancy. J Obstet Gynaecol Br Emp 63:592–593

    Article  CAS  PubMed  Google Scholar 

  41. Powell JL et al (2002) Metastatic endocervical adenocarcinoma presenting as a virilizing ovarian mass during pregnancy. Obstet Gynecol 100:1129–1133

    PubMed  Google Scholar 

  42. Raghunandan G, Martin TC (2005) Bilateral Krukenberg ovarian tumours complicated by pregnancy in an Antiguan woman of African ethnicity. West Indian Med J 54:348–349

    Article  CAS  PubMed  Google Scholar 

  43. Scharl A et al (1996) Gastric cancer during early pregnancy. Two case reports. Arch Gynecol Obstet 258:151–154

    Article  CAS  PubMed  Google Scholar 

  44. Sebire NJ et al (2000) Appendiceal adenocarcinoma with ovarian metastases in the third trimester of pregnancy. J R Soc Med 93:192–193

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Silva PD et al (1988) Clinical and ultrastructural findings of an androgenizing Krukenberg tumor in pregnancy. Obstet Gynecol 71:432–434

    CAS  PubMed  Google Scholar 

  46. Singhal SR et al (2009) Metastatic bilateral malignant ovarian tumors associated with pregnancy. Taiwan J Obstet Gynecol 48:167–168

    Article  PubMed  Google Scholar 

  47. Spadoni LR et al (1965) Virilization coexisting with Krukenberg tumor during pregnancy. Am J Obstet Gynecol 92:981–991

    Article  CAS  PubMed  Google Scholar 

  48. Tamussino K et al (1995) Gastric carcinoma presenting as a Krukenberg tumor in the 24th week of gestation. Eur J Obstet Gynecol Reprod Biol 62:251–252

    Article  CAS  PubMed  Google Scholar 

  49. Taylor J et al (2009) Irinotecan use during pregnancy. Obstet Gynecol 114:451–452

    Article  PubMed  Google Scholar 

  50. Testa AC et al (2009) Color Doppler sonographic features of a Krukenberg tumor in pregnancy. J Ultrasound Med 28:695–698

    PubMed  Google Scholar 

  51. Tsukamoto N et al (1986) Carcinoma of the colon presenting as bilateral ovarian tumors during pregnancy. Gynecol Oncol 24:386–391

    Article  CAS  PubMed  Google Scholar 

  52. Van Calsteren K et al (2010) Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol 28:683–689

    Article  PubMed  Google Scholar 

  53. Chung HW, Noh SH, Lim JB (2010) Analysis of demographic characteristics in 3242 young age gastric cancer patients in Korea. World J Gastroenterol 16:256–263

    Article  PubMed  PubMed Central  Google Scholar 

  54. Moghazy D, Al-Hendy O, Al-Hendy A (2014) Krukenberg tumor presenting as back pain and a positive urine pregnancy test: a case report and literature review. J Ovarian Res 7:36

    Article  PubMed  PubMed Central  Google Scholar 

  55. Tan KL et al (2010) Krukenberg tumors of colorectal origin: a dismal outcome—experience of a tertiary center. Int J Colorectal Dis 25:233–238

    Article  PubMed  Google Scholar 

  56. Zhang J et al (2014) Krukenberg tumor in a pregnant patient with severe preeclampsia. Exp Ther Med 7:1476–1480

    PubMed  PubMed Central  Google Scholar 

  57. Hornung M et al (2008) A case of virilization induced by a Krukenberg tumor from gastric cancer. World J Surg Oncol 6:19

    Article  PubMed  PubMed Central  Google Scholar 

  58. Forest MG et al (1978) Approach to the mechanism of androgen overproduction in a case of Krukenbery tumor responsible for virilization during pregnancy. J Clin Endocrinol Metab 47:428–434

    Article  CAS  PubMed  Google Scholar 

  59. Lu LC et al (2012) Metastasectomy of Krukenberg tumors may be associated with survival benefits in patients with metastatic gastric cancer. Anticancer Res 32:3397–3401

    PubMed  Google Scholar 

  60. Ridwelski K et al (2001) Combination chemotherapy with docetaxel and cisplatin for locally advanced and metastatic gastric cancer. Ann Oncol 12:47–51

    Article  CAS  PubMed  Google Scholar 

  61. Cardonick E, Lacobucci A (2004) Use of chemotherapy during human pregnancy. Lancet Oncol 5:283–291

    Article  CAS  PubMed  Google Scholar 

  62. Cirillo M et al (2012) Irinotecan during pregnancy in metastatic colon cancer. Tumori 98:155e–157e

    PubMed  Google Scholar 

  63. Wu XJ et al (2013) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves the survival of gastric cancer patients with ovarian metastasis and peritoneal dissemination. Tumour Biol 34:463–469

    Article  CAS  PubMed  Google Scholar 

  64. Ortega-Deballon P et al (2011) Childbearing after hyperthermic intraperitoneal chemotherapy: results from an international survey. Ann Surg Oncol 18:2297–2301

    Article  PubMed  PubMed Central  Google Scholar 

  65. Gill RS et al (2011) Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: a systematic review of survival, mortality, and morbidity. J Surg Oncol 104:692–698

    Article  PubMed  Google Scholar 

  66. Fagotti A et al (2011) HIPEC in recurrent ovarian cancer patients: morbidity-related treatment and long-term analysis of clinical outcome. Gynecol Oncol 122:221–225

    Article  PubMed  Google Scholar 

  67. Kim HK et al (2001) Prognostic factors of Krukenberg’s tumor. Gynecol Oncol 82:105–109

    Article  CAS  PubMed  Google Scholar 

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Author notes

    Authors and Affiliations

    1. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan

      Michiko Kodama

    2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA

      Aida Moeini, Hiroko Machida, Brendan H. Grubbs & Koji Matsuo

    3. Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA

      Erin A. Blake

    4. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA

      Koji Matsuo

    Authors
    1. Michiko Kodama
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    2. Aida Moeini
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    3. Hiroko Machida
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    6. Koji Matsuo
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    Correspondence to Koji Matsuo.

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    Funding

    This study was funded by Ensign Endowment for Gynecologic Cancer Research (K.M.).

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    All authors declare that there is no conflict of interest for the study.

    Source of the study

    Ensign Endowment for Gynecologic Cancer Research.

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    There is no conflict of interest for any authors in the study.

    Additional information

    Michiko Kodama and Aida Moeini have contributed equally to the work.

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    Kodama, M., Moeini, A., Machida, H. et al. Feto-maternal outcomes of pregnancy complicated by Krukenberg tumor: a systematic review of literature. Arch Gynecol Obstet 294, 589–598 (2016). https://doi.org/10.1007/s00404-016-4048-3

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    • DOI: https://doi.org/10.1007/s00404-016-4048-3

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