title: Role of ultrasonography and contrast-enhanced ultrasonography in a case of Krukenberg tumor.
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.
authors.affiliation: Paola Tombesi, Francesca Di Vece, Francesca Ermili, Sergio Sartori, Section of Interventional Ultrasound, St. Anna Hospital, 44100 Ferrara, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tombesi
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Vece
authors.forename: Francesca
authors.initials: F
authors.lastname: Ermili
authors.forename: Fabio
authors.initials: F
authors.lastname: Fabbian
authors.forename: Sergio
authors.initials: S
authors.lastname: Sartori
keywords: Adnexal masses; Contrast-enhanced ultrasonography; Gastric cancer; Krukenberg tumor; Ultrasonography