Exophthalmos Revealing a Krukenberg Tumor: A Case Presentation and Review of the Literature

BACKGROUND: Krukenberg tumor is a well-known ovarian metastasis, usually of signet ring cell carcinoma in female patients. In the literature, there are a few documented cases of ocular metastasis in patients with Krukenberg tumor. CASE PRESENTATION: We report the case of a 35-year-old single Moroccan woman. She presented chronic pelvic pain, hematemesis and blurring of vision in the left eye. Clinical examination showed a pelvic mass and an exophthalmos with a divergent strabismus in the left eye. Pelvic and abdominal ultrasound showed a right tissular ovarian mass. Computed tomography (CT) scan of the abdomen and pelvis revealed an ovarian tumor and bone metastasis. Orbital magnetic resonance imaging (MRI) showed a hypertrophy of the left inferior rectus muscle behind the exophthalmos. Stomach endoscopy revealed an ulcerated and protruded mass of the antro-fundic junction. Histopathology and immunohistochemistry showed an infiltration of the gastric mucosa by atypically isolated signet ring cells similar to the tumor cells found in the ovarian histopathological exams. DISCUSSION: Krukenberg tumor is an uncommon metastatic tumor of the ovary. This article provides an overview of the major pathological manifestations of Krukenberg tumor, patient characteristics, clinical and laboratory features of the disease, prognostic factors, and current knowledge about its pathogenesis.