Fig. 15

Krukenberg tumors and peritoneal carcinomatosis secondary to a diffuse gastric adenocarcinoma with signet ring cells, in a 32-year-old woman with non-specific abdominal discomfort. First, an abdominal ultrasound was performed, which showed two voluminous solid masses in the lower half of the abdomen (a, b) and demonstrated vascularity within them by color Doppler (c). Axial (d–f) and coronal (g) CT images with intravenous contrast in the portal phase confirmed the presence of two large solid masses of probable adnexal origin (white asterisks), associated with ascitic fluid (blue arrows) and stranding of the omental fat (yellow arrows) suspicious of peritoneal carcinomatosis. Note also the presence of an ill-defined thickening of the gastric wall in the subcardial region, with extension toward the gastrohepatic ligament, suggestive of a primary gastric malignancy (d, red arrows). Subsequently, gastroscopy with biopsy was performed, confirming the diagnosis of a gastric adenocarcinoma with signet ring cells. Palliative debulking surgery with bilateral oophorectomy was decided after multidisciplinary discussion of the case. h Intraoperative view of the pelvis shows the left adnexal mass (white asterisk) and the inferior pole of the right adnexal mass (white arrow), which extends superiorly toward the upper abdomen