Diagnostic and therapeutic challenges of Krukenberg tumors: Case report of an atypical presentation with obstructive renal failure

Krukenberg tumors are rare metastatic ovarian neoplasms, most commonly originating from gastrointestinal adenocarcinomas, and are histologically characterized by mucin-producing signet-ring cells. Their clinical and radiological presentation is often nonspecific, which may delay diagnosis and complicate differentiation from primary ovarian malignancies. Imaging plays a crucial role in the initial assessment, with ultrasonography typically revealing bilateral or unilateral adnexal masses that are heterogeneous, predominantly solid, and associated with irregular margins and internal necrotic areas. Transvaginal ultrasound further refines lesion characterization by demonstrating a disorganized architecture with mixed solid and cystic components, highly suggestive of malignancy. Definitive diagnosis relies on histopathological examination supported by immunohistochemical profiling to identify the primary origin. Early recognition is essential given the poor prognosis and the need for multidisciplinary management. In this context, we report a case of a metastatic ovarian tumor consistent with a Krukenberg-type lesion.