Presentation
Menorrhagia.
Patient Data
There are two adjacent heterogenous midline pelvic cystic lesions with the larger one on the right side showing T1W high signal intensity (hemorrhagic/Proteinaceous components).
After contrast administration multiple small enhanced protruding solid components (papillary projections) one of them shows restricted diffusion. Pelvic-free fluid is seen surrounding the lesions.
The left ovary could not be seen separately.
The right ovary seems to be separable and unremarkable with a small follicle.
There is a short segment circumferential wall thickening of the sigmoid colon, fixed on all sequences, which may suggest a neoplastic process.
No lymphadenopathy. The uterus appears unremarkable. The endometrial thickness measures about 0.7 cm. Normal junctional zone and cervix.
In keeping with short segment wall thickening of the sigmoid colon, features raising the possibility of left ovarian metastasis mucinous adenocarcinoma.
Other possibilities includes mucinous cystadenocarcinoma, clear cell ovarian carcinoma or endometrioid carcinomas for histopathological correlation.
There is a fixed short segment wall thickening of the sigmoid colon with surrounding regional lymph nodes, which may suggest a neoplastic process.
No free fluid.
No pneumoperitoneum.
No abnormal bowel dilatation.
Case Discussion
Metastases to the ovary are uncommon but may result from gastric cancer, colon cancer, pancreatic cancer, breast cancer, and melanoma.
A Krukenberg tumor is an ovarian metastasis of a mucin-producing tumor, typically gastric or colonic adenocarcinoma.
Colorectal carcinoma (most commonly adenocarcinoma) is the most common malignancy of the GI tract. Rare subtypes include mucinous carcinoma of the colon and neuroendocrine carcinoma.
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