DIAGNOSTICS AND THERAPEUTICS IN KRUKENBERG TUMORS: LESSONS FROM A GYNECOLOGY DEPARTMENT
Authors:   Department of Gynecology-Obstetrics, Mohammed IV University Hospital., Bouchaar M.A , Bellejdel I. ,   Department of Gynecology-Obstetrics, Mohammed IV University Hospital., Akouh N. ,   Department of Anatomopathology, Mohamed IV University Hospital., Taheri H. ,   Department of Gynecology-Obstetrics, Mohammed IV University Hospital., Saadi H. ,   Department of Gynecology-Obstetrics, Mohammed IV University Hospital., Mimouni A. ,   Department of Gynecology-Obstetrics, Mohammed IV University Hospital.
Published: January 2024

Background:Krukenberg tumors, metastatic ovarian neoplasms arising predominantly from the gastrointestinal tract, pose intricate challenges in diagnosis and treatment. This abstract amalgamates insights from a case series conducted at the Gynecology and Obstetrics Department of Mohammed VI University Hospital, Oujda, spanning from July 2020 to May 2022, and a comprehensive literature review. The aim is to provide a nuanced understanding of the diagnostic and therapeutic complexities inherent in these enigmatic tumors. Diagnostic Challenges: The presented cases underscore the complexity of diagnosing Krukenberg tumors, emphasizing the need for a swift and accurate approach. Madame H.Y.'s case illustrates the rapid onset and aggressive progression, necessitating advanced imaging modalities guided by pelvic ultrasound and confirmed by a thoraco-abdomino-pelvic CT scan. Elevated CA-125 levels added diagnostic support, aligning with established literature. Histological confirmation through exploratory laparoscopy and biopsies echoes existing practices, emphasizing the crucial role of tissue sampling for precision. Madame E.B.'s case introduces a layer of complexity with a gastric origin, elucidating the challenges in discerning primary sites. A comprehensive diagnostic approach, involving laparoscopy, peritoneal biopsies, and upper endoscopy, was imperative in unraveling the disease's etiology. Therapeutic Considerations: The aggressive nature of Krukenberg tumors, exemplified in the cases of Madame H.Y. and Madame E.B., prompts critical reflections on current therapeutic approaches. Palliative chemotherapy, a mainstay for advanced ovarian cancers, offers temporary relief, necessitating exploration of more effective systemic treatments. Madame A.H.'s case, diagnosed at an advanced stage, underwent postoperative palliative chemotherapy, aligning with literature emphasizing the palliative nature of advanced Krukenberg tumor treatment. Madame M.R.'s case introduces optimism with surgery followed by adjuvant chemotherapy, hinting at potential benefits of early intervention. This aligns with studies suggesting that earlier detection may lead to more successful treatment strategies. Cautious optimism is warranted, requiring further research validation. Conclusion: The presented case series and literature review offer a comprehensive perspective on the diagnostic challenges and therapeutic nuances of Krukenberg tumors. The multifaceted nature of these tumors demands a nuanced diagnostic approach, while their aggressive behavior underscores the urgency for more effective therapeutic strategies. Madame M.R.'s case sparks optimism for early intervention, necessitating continued collaboration between clinicians and researchers to refine diagnostic accuracy and enhance therapeutic outcomes for patients grappling with this challenging malignancy.