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Minerva Obstetrics and Gynecology 2021 May 04

DOI: 10.23736/S2724-606X.21.04797-7


language: English

Clinics and pathology of Krukenberg Tumor: a systematic review and meta-analysis

Ruggero LIONETTI 1, Marcello DE LUCA 1 , Antonio RAFFONE 2, Antonio TRAVAGLINO 3, Alberto COPPELLOTTI 1, Roberto PELTRINI 1, Umberto BRACALE 1, Michele D’AMBRA 1, Luigi INSABATO 1, Fulvio ZULLO 2, Maria D’ARMIENTO 1, Francesco CORCIONE 1

1 Minimal Invasive Oncological and General Surgery, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy; 2 Gynecology and Obstetrics, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; 3 Pathological Anatomy, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy

BACKGROUND: Krukenberg tumor (KT) is defined as a secondary neoplasm of the ovary. While ovarian metastases account for about 30% of ovarian tumors, KTs are rare, accounting for about 1-2% of the total. The rarity of KT is at least in part responsible for the lack of a precise clinic-pathological characterization of these tumors. Clinically, KT may have a subtle clinical presentation, with few symptomatic manifestations and nonspecific clinical signs, even though in Literature there is disagreement about the clinical presentation of these patients; such difficulties in the diagnostic framework often leads to a delayed diagnosis with serious consequences on the patient outcome.
OBJECTIVES: We aimed to provide a clinico-pathological characterization of Krukenberg Tumor (KT) through a systematic review and meta-analysis.
METHODS: Electronic databases were searched for all studies assessing clinicopathological features of KT series. Pooled prevalence of each clinical or pathological factor was calculated according to the random-effect model.
RESULTS: Forty-eight studies with 3025 KT patients were included; 39.7% of patients were ≥50 and 39.8% were postmenopausal. The most common primary tumor sites were stomach (42.5%), colon-rectum (26.1%), breast (9.3%), and appendix (5%); 48.7% of KTs were synchronous with the primary tumor, 64.3% were bilateral, 40.5% had a diameter ≥10 cm; 55.3% showed extraovarian extent and 49% showed peritoneal involvement. The most common presenting symptoms were ascites (51.7%), palpable mass (31.3%), pain (29.3%), abdominal distention (28.7%), irregular bleeding (9.1%), asymptomatic (11.2%); 27.5% of patients showed increased serum level of CA125, while 29.4% showed increased CEA levels. Cytokeratin-7 was positive in 34.5% of cases and cytokeratin-20 in 34.3%.
CONCLUSIONS: KT shows a highly variable presentation. Understanding the prevalence of clinico-pathological factors may be helpful to improve the diagnosis and management of KT.

KEY WORDS: Krukenberg; Tumor; Ovaries; Ovary; Metastases; Metastatic

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