# Bilateral ovarian metastases from gastric signet-ring cell carcinoma in an 18-year-old: a case report and narrative review

## TL;DR

An 18-year-old with rare ovarian metastases from gastric cancer highlights the need for early diagnosis in young patients.

## Contribution

A rare adolescent case of Krukenberg tumor combined with a focused literature review improves clinical awareness for young patients.

## Key findings

- KTs in adolescents are rare, with most cases showing bilateral ovarian involvement and gastric origin.
- Diagnostic delays are common due to nonspecific symptoms and low clinical suspicion in young patients.
- Multimodal treatment strategies have poor outcomes, emphasizing the need for early endoscopic assessment.

## Abstract

Krukenberg tumors (KTs) are rare metastatic ovarian neoplasms, most frequently secondary to gastric adenocarcinomas, and typically occur in women aged 30–60 years. Their presentation in adolescents is exceedingly uncommon and often leads to diagnostic delays due to nonspecific symptoms and low clinical suspicion.

We describe the case of an 18-year-old female presenting with progressive abdominal pain and bilateral adnexal masses. Imaging suggested advanced ovarian pathology, and surgical exploration with histopathological evaluation confirmed metastatic signet-ring cell carcinoma. Upper gastrointestinal endoscopy subsequently identified a poorly differentiated gastric adenocarcinoma, establishing the diagnosis of KT.

To place this case in context, a narrative literature review was performed using PubMed, Google Scholar, and ScienceDirect. English-language case reports and case series describing KTs in patients aged ≤20 years were selected. Fifteen studies were analyzed regarding clinical presentation, histopathological features, diagnostic approach, and patient outcomes.

The majority of reported cases demonstrated bilateral ovarian involvement, vague abdominal symptoms, and gastric origin. Diagnostic delays were frequent, and prognosis remained poor despite multimodal treatment strategies.

This case highlights the importance of considering metastatic gastrointestinal malignancies in the differential diagnosis of ovarian tumors in adolescents and emphasizes the value of early endoscopic assessment. By combining a rare adolescent case with a focused literature review, this work provides one of the few comprehensive syntheses of KTs in patients under 20 years, offering a unique contribution to improving clinical awareness and guiding future diagnostic strategies.