34 Jun SY and Park JK yet the studies performed in the West on Krukenberg tumor were on patients with primary colon cancer in most cases. Thus, it was considered that the incidence and prognosis in Korea, where gas- tric cancer is more prevalent, would be different．In our study, statistical analysis was not performed on all the 693 gastric cancer patients treated during the same period and so comparison with all the patients who had undergone a curative gastric resection for stomach cancer was difficult. It was particular that 6 patients (27.3%) belonged to the AJCC disease stage 2, which was the most preva- lent stage. Although this may be due to several reasons, we can speculated that this due to the effect of mass screening programs that have been widely performed recently, and so the number of patients lower than stage 2 became abundant. Indeed, according to the result of studies recently performed by Nam et al.(7) at the National Cancer Center, of the 18,414 patients who received physi- cal check-ups, gastric cancer was detected in 81 patients (0.44%). Among these 81 patients, 80% had early gastric cancer, which shows that the disease stage of the diagnosed gastric cancer has become substantially lower. Krukenberg tumor was reported for the first time in 1896 by Freidrich Ernst Krukenberg. Afterward, the definition of the dis- ease and the diagnostic criteria were very confusing. Initially, all metastatic ovarian cancers were termed as Krukenberg tumor. Since the confusion was induced by the term, Novak and Gray(8) in 1938 proposed the diagnostic criteria that classical Krukenberg tumor should composed of signet-ring cell carcinoma within a dense fibroblastic stroma in the ovary. The WHO(9) in 1973 estab- lished the diagnostic standard, which is the diagnostic standard that has been applied until now. Almost all Krukenberg tumors are the diffused type according to the Luaren’s classification of primary gastric cancer. Nevertheless, it has been reported that although it is a very rare tumor, this tumor is almost always associated with dis- seminated disease like the intestinal type adenocarcinoma of gastric cancer, which has metastasizes to the ovary.(10) Involvement of ovary by intestinal type gastric carcinoma compared with that on signet-ring cell carcinoma that result in the Krukenberg tumor may be confused with primary ovarian mucinous neoplasm, but such cases were not detected at our series. Several mechanism have been suggested to explain the progres- sion and recurrence pathway of gastric cancer such as lymphatic spread, hematogenous spread, direct invasion, peritoneal seeding, etc. Among them, the incidence of hematogenous recurrence is highest. Although Krukenberg tumor also may be induced by com- plex mechanisms, as a factor for metastasis, lymph node metastasis is considered to be the most potent risk factor for recurrence.(11,12) Therefore, if the national cancer screening program, including esophago-gastroscopic screening, becomes active and so the diag- nosis of early gastric cancer is increased and appropriate treatments could be administered early, the incidence of Krukenberg tumor also may be changed, and the distribution of the primary disease stage may become different. It has been reported that the incidence of Krukenberg tumor is approximately 30~40% of all metastatic ovarian cancers, it is a rare tumor (approximately 2% of all ovarian cancers), and the progno- sis is awful to the level that all the patients die within 1 year after diagnosis.(13) In the east Asia where the incidence of gastric can- cer is high, Krukenberg tumor has been shown to occur relatively frequently as approximately 4.4~6.7% within 3 years after surgery in the female patients who have received gastrectomy.(1,3,11) In this study, similarly, although it was difficult to infer the incidence of metachronous tumor during the same period, during the rela- tively long follow-up observation (27 years), approximately 3.2％ of the patients who received gastrectomy after the diagnosis of gastric cancer developed Krukenberg tumor. The primary lesion of Krukenberg tumor is in the order of the colon, pancreas and breast in the West, and the prognosis varies depending on the primary le- sion. On the other hand, in the east Asia, the cause is gastric cancer in many cases, followed by cancer of the colon, breast, small intes- tine, gallbladder and bladder.(13-15) Most patients with Krukenberg tumors present with symtoms related to ovarian tumors including abdominal pain and the tumor can be palpated in more than 50% of cases. Rarely, patients may present with abnormal uterine bleeding.(16）In such situation, early clinical symptoms of Krukenberg tumors are vague and the primary gastric cancer may not manifest itself until later in most cases. So making an early diagnosis is difficult and this results in often detecting inoperable cases. In our study, unexpectedly, there was only one patients case in whom typical ascites was detected by a physical examination, and other than that, most early symptoms were lower abdominal pain, discomfort, etc. and they were con- sidered to be nonspecific symptoms, so making the early diagnosis was difficult, and this may lower the postsurgical survival rate. Therefore, the most important factor for allowing the complete re- section of tumors may be physicians being aware of the possibility of Krukenberg tumor. In several studies, it has been reported that premenopausal Krukenberg tumor patients were more prevalent and the tumor was multicentric in most cases.(17) In our study, similarly, there were 13 premenopausal patients (59.1%) and 18