Krukenberg tumors of the ovary: a clinicopathologic analysis of 27 cases.

A series of 27 typical Krukenberg tumors of the ovary were analyzed. By definition, all examples were characterized by the presence of mucinous signet-ring carcinoma cells within a cellular, nonneoplastic ovarian stroma. The patients' ages ranged from 20-70 years; almost one-half were 40 years of age or younger. A primary carcinoma of the stomach (16 cases) or colon (four cases) was found in 20 (90.9%) of 22 patients with available follow-up data. The primary gastrointestinal carcinomas had been diagnosed before emergence of the ovarian tumors in only five cases. The ovarian and gastrointestinal tumors were synchronously diagnosed in ten cases, while in five instances the primary carcinomas were not discovered until after the ovarian tumors had been treated. An acceptable primary extraovarian cancer was not detected in two women. Both had bilateral Krukenberg tumors and died with widespread carcinomatosis less than two years postoperatively. Typically, the ovarian tumors were bilateral, asymmetrically large and solid. Important histologic features included a greater abundance of intracellular neutral glycoproteins than acidic mucins, a storiform pattern of hyperplastic cortical stromal cells (44.4%) and carcinomatous emboli (51.6%). While the entity of "primary" Krukenberg tumor cannot be unequivocally denied, all women with typical Krukenberg tumors should be considered as having metastatic carcinoma, usually from the stomach, until proven otherwise.