BILATERAL KRUKENBERG TUMOR IN A PATIENT WITH CROHN'S DISEASE: CASE REPORT

Case Presentation A 39-year-old female patient with stenosing ileocolonic Crohn’s disease since 2004 presented in 2022 with nausea, postprandial fullness, and diarrhea. Colonoscopy revealed stenosis in the descending colon and sigmoid. CT enterography identified an 11 cm stricture at the hepatic flexure. She underwent right ileocolectomy with ileostomy. Histopathology showed mixed colonic adenocarcinoma (40% signet ring cells). Chemotherapy with XELOX was initiated but switched to bFOL due to toxicity. Six months later, carcinoembryonic antigen levels increased, and a cystic mass was detected in the supravesical region. PET-CT suggested ovarian implantation. In 2023, she underwent right salpingo-oophorectomy, and histopathology confirmed metastasis of colorectal adenocarcinoma. Treatment included chemotherapy with 5-FU + Irinotecan, followed by total hysterectomy and prophylactic left salpingo-oophorectomy in 2024. PET-CT detected residual lesions, which were treated with radiotherapy. Genetic testing revealed no mutations in KRAS, NRAS, or BRAF. Palliative chemotherapy with Irinotecan and Cetuximab was initiated.

Discussion In Brazil, colorectal cancer (CRC) is the second most common cancer in women and the third in men. Patients with Crohn’s disease (CD) have a 2- to 6-fold increased risk of developing CRC, which accounts for 10–15% of deaths in inflammatory bowel diseases. CRC associated with CD tends to affect younger individuals and is often diffuse, extensive, multifocal, and located in the right colon. Krukenberg tumors (KT) are ovarian metastases, typically from gastrointestinal cancer. Approximately 76% of KTs originate from the stomach and 11% from the colorectum. Immunostaining for CK20 and CK7 helps distinguish ovarian metastases from primary ovarian neoplasms; colorectal tumors are CK20 positive and CK7 negative. Up to 30% of ovarian malignancies are metastatic, affecting younger women with a median survival of 19–27 months. KTs from colorectal cancer have a better prognosis when unilateral. Prophylactic oophorectomy is recommended post-menopause and may be considered pre-menopause to reduce the risk of metachronous metastasis and primary ovarian cancer.

Conclusion This report highlights the importance of CRC screening and prevention in patients with inflammatory bowel disease, emphasizing the complex management of associated ovarian metastases. Prophylactic oophorectomy is recommended to improve prognosis and survival, particularly in premenopausal women and in cases with synchronous microscopic metastases.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025