Diagnostic Ultrasound - Abdomen and Pelvis

Ovarian Metastases Including Krukenberg Tumor
Diagnoses: Female Pelvis
TERMINOLOGY
• Secondary (metastatic) neoplasms to ovary
• Krukenberg tumor: Subtype of metastatic tumors that
contain > 10% mucin-filled signet cells in cellular stroma
• High-stage mucinous tumors involving ovary frequently
represent metastases from extraovarian primary sites and
are often misdiagnosed as primary ovarian mucinous
tumors
IMAGING
• Bilateral ovarian masses in patients with known primary
carcinoma
• Metastases to ovary are usually solid masses
• Often large
• Lobulated masses with smooth external contour
• US
○ Solid or cystic and solid
○ Solid components demonstrate vascularity on Doppler
evaluation
KEY FACTS
○ Typically heterogeneous
○ May be complicated by hemorrhage
• CECT
○ Solid components often demonstrate heterogeneous
enhancement
○ Cystic and necrotic areas do not enhance
• MR
○ T2WI: Solid components demonstrate heterogeneous
signal intensity
○ T1WI C+: Solid components show marked
heterogeneous enhancement
• PET/CT is modality of choice for tumor staging and shows
increased metabolic uptake in ovarian metastases
TOP DIFFERENTIAL DIAGNOSES
• Primary ovarian cancer
• Ovarian lymphoma
(Left) Transabdominal US in a
woman with metastatic
gastric adenocarcinoma shows
large adnexal mass with a
solid center and peripheral
cystic areas. (Right)
Longitudinal color Doppler US
in the same patient shows
flow in the solid component of
the adnexal mass.
(Left) Longitudinal color
Doppler US shows flow within
a solid large right adnexal
mass in a patient with
metastatic melanoma to the
ovary. Note the free fluid in
the cul-de-sac. (Right) Coronal
CECT in a 45-year-old woman
shows large bilateral complex
cystic and solid adnexal
masses ſt. The patient had a
recent history of colon cancer
and these were confirmed
metastases at oophorectomy.
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