Case Report
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World J Radiol. Aug 28, 2013; 5(8): 321-324
Published online Aug 28, 2013. doi: 10.4329/wjr.v5.i8.321
Role of ultrasonography and contrast-enhanced ultrasonography in a case of Krukenberg tumor
Paola Tombesi, Francesca Di Vece, Francesca Ermili, Fabio Fabbian, Sergio Sartori
Paola Tombesi, Francesca Di Vece, Francesca Ermili, Sergio Sartori, Section of Interventional Ultrasound, St. Anna Hospital, 44100 Ferrara, Italy
Fabio Fabbian, Department of Internal Medicine, St. Anna Hospital, 44100 Ferrara, Italy
Author contributions: Tombesi P and Sartori S designed the report; Di Vece F, Ermili F, Fabbian F were attending doctors for the patients and performed pathological examinations; Tombesi P, Sartori S performed image diagnosis; Sartori S organized the report; Di Vece F, Ermili F and Fabbian F wrote paper; all authors approved the final version.
Correspondence to: Sergio Sartori, MD, Section of Interventional Ultrasound, St. Anna Hospital, Corso Giovecca 203, 44100 Ferrara, Italy. srs@unife.it
Telephone: +39-532-236551 Fax: +39-532-236738
Received: May 23, 2013
Revised: July 7, 2013
Accepted: August 4, 2013
Published online: August 28, 2013
Processing time: 114 Days and 0.2 Hours
Abstract

We report a case of Krukenberg tumor of gastric origin with adnexal metastasis, in which ultrasonography (US) and contrast-enhanced US (CEUS) played a key diagnostic role. An 64-year-old female patient was referred to our department for abdominal pain, nausea and ascites. US examination was performed as first line diagnostic imaging approach, confirming the presence of ascites and detecting marked thickness of the gastric wall and a right adnexal mass. CEUS was immediately performed and showed arterial enhancement followed by wash-out in the venous phase of both the gastric wall and the adnexal mass, suggesting the diagnosis of gastric cancer with right adnexal metastasis (Krukenberg syndrome). The patient underwent US-guided paracentesis and esophagogastroduodenoscopy that showed linitis plastica. Cytologic examination of the peritoneal fluid revealed the presence of signet-ring cells, and histologic examination of the specimen obtained by endoscopic biopsy showed primary gastric mucus-producing adenocarcinoma with signet-ring cells. Although transvaginal US is undoubtedly the method of choice to evaluate ovarian tumors, abdominal US and CEUS can provide key diagnostic elements, supporting clinicians in the first steps of the diagnostic work-up of abdominal and pelvic masses.

Keywords: Adnexal masses; Gastric cancer; Krukenberg tumor; Ultrasonography; Contrast-enhanced ultrasonography

Core tip: Transvaginal ultrasonography (TV-US) is the method of choice to evaluate ovarian tumors, but abdominal US enables to detect masses in both upper and lower abdomen, providing useful information when Krukenberg tumor is suspected. Moreover, contrast-enhanced US (CEUS) can be immediately performed to define the microvascularisation of the lesions, and the presence of arterial enhancement followed by wash-out in the venous phase is strongly suspicious of malignancy. US and CEUS can provide key diagnostic elements, supporting clinicians in the first steps of the diagnostic work-up of abdominal and pelvic masses.