Concurrent rectosigmoid cancer and Krukenberg tumor in a pregnant patient: A rare clinicopathological presentation - Case report

Introduction and importance: The occurrence of ovarian tumors during pregnancy is relatively low, with an incidence of approximately 0.05 %. Both primary ovarian cancer and metastatic malignancies are uncommon in pregnant women, and there is often a delay in diagnosing these conditions. Case presentation: We report the case of rectal cancer with ovarian metastasis discovered in a 36-year-old multiparous pregnant woman who presented at 21 weeks gestation with constipation and increased abdominal volume over the past three weeks. These symptoms were associated with loss of appetite and general fatigue. Further investigations revealed a 12 x 9 cm mass on the left side of the uterus and a 5.2 x 4 x 3.6 cm mass in the recto-sigmoid region. Initially, the patient underwent left adnexectomy, peritoneal cytology, biopsies of the peritoneum, epiploic region, and right ovary. Subsequently, the pregnancy was continued until 34 weeks' amenorrhea, when the fetus was extracted, and a complete surgical procedure was performed, including total hysterectomy, right adnexectomy, resection of the recto-sigmoid tumor with appendectomy and infra-gastric omentectomy. After surgery, the patient received adjuvant chemotherapy. Clinical discussion: It is important to consider the possibility of malignancy during pregnancy when atypical clinical presentations occur. Gastrointestinal cancer is the most common cause of Krukenberg's tumor in pregnant women. Early diagnosis of cancer at an operable stage is essential to improve prognosis. Conclusions: This clinical case highlights the rarity of Krukenberg's tumor during pregnancy and the challenges encountered in diagnosing and treating this disease.