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Tumores de Krukenberg : uma reflexão com dois séculos de evolução
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O Tumor de Krukenberg é uma metástase ovárica que, segundo a OMS, apresenta as seguintes características: envolvimento do estroma, presença de células neoplásicas em anel de sinete produtoras de muco e proliferação sarcomatóide do estroma ovárico. Este tumor pode ter origem em diferentes órgãos: tiróide, mama, trato gastrointestinal, bexiga, pâncreas e trato genital feminino. É mais frequentemente originário do trato gastrointestinal, sobretudo do estômago. Tem uma incidência de 0,000082 a 0,000164% na população portuguesa e corresponde a 30 a 40% dos tumores secundários do ovário. Uma das suas características é a bilateralidade das metástases (70 a 80% dos casos). O prognóstico destes doentes é desfavorável por ser habitualmente diagnosticado em estadios avançados da doença. Existem vários factores que condicionam o prognóstico nomeadamente, o local de origem, a sincronicidade, a presença de ascite, a disseminação peritoneal, a extensão do tratamento cirúrgico. O diagnóstico destes tumores é muitas vezes um achado. Faz-se normalmente através da clínica e dos exames complementares de diagnóstico. A cura é muito rara e o seu tratamento visa sobretudo o aumento da esperança média de vida e a melhoria da qualidade de vida. Consiste no tratamento cirúrgico (citoredução máxima) e quimioterapia adjuvante (sistémica e eventualmente intraperitoneal).
Krukenberg tumor metastasizes to the ovary and, according to the WHO, has the following characteristics: stromal involvement, presence of signet-ring cells producing mucus and sarcomatoid proliferation of the ovarian stroma. This tumor is originated in different organs: thyroid, breast, gastrointestinal tract, bladder, pancreas, and female genital tract, most often originating from the gastrointestinal tract, mainly from the stomach. It is a tumor that appears in about 0.000082 to 0.000164% in the Portuguese population and corresponds to 30 to 40% of the secondary tumors of the ovary. One of its characteristics is the bilaterality of metastases, which occurs in 70 to 80% of cases. The prognosis of these patients is poor since the diagnosis is only obtained in advanced stages of the disease. There are several factors that modify the prognosis of these patients, namely the place of origin, synchronicity, the presence of ascites, peritoneal dissemination, metastectomy and surgical cytoreduction. The diagnosis of these tumors is made based on clinical history, objective examination, imaging, tumor markers, endoscopic methods, histopathology and immunohistochemistry. Its treatment aims to increase the life expectancy of these patients and consists of cytoreductive surgery, bilateral oophorectomy and may be associated with systemic and intraperitoneal chemotherapy.
Krukenberg tumor metastasizes to the ovary and, according to the WHO, has the following characteristics: stromal involvement, presence of signet-ring cells producing mucus and sarcomatoid proliferation of the ovarian stroma. This tumor is originated in different organs: thyroid, breast, gastrointestinal tract, bladder, pancreas, and female genital tract, most often originating from the gastrointestinal tract, mainly from the stomach. It is a tumor that appears in about 0.000082 to 0.000164% in the Portuguese population and corresponds to 30 to 40% of the secondary tumors of the ovary. One of its characteristics is the bilaterality of metastases, which occurs in 70 to 80% of cases. The prognosis of these patients is poor since the diagnosis is only obtained in advanced stages of the disease. There are several factors that modify the prognosis of these patients, namely the place of origin, synchronicity, the presence of ascites, peritoneal dissemination, metastectomy and surgical cytoreduction. The diagnosis of these tumors is made based on clinical history, objective examination, imaging, tumor markers, endoscopic methods, histopathology and immunohistochemistry. Its treatment aims to increase the life expectancy of these patients and consists of cytoreductive surgery, bilateral oophorectomy and may be associated with systemic and intraperitoneal chemotherapy.
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Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Tumor de Krukenberg Metástases ováricas Manifestações clínicas Marcha diagnóstica Tratamento