Krukenberg tumor secondary to an incidentally discovered gall bladder carcinoma: a rare occurrence.

A 35-year-old lady presented with abdominal lump in abdomen for the past 2 months. There was no history of hematemesis, altered bowel habits, or jaundice. On examination, two large separate bilateral lumps were palpable. Computerized tomogram (CT) of abdomen revealed two large heterodense masses one from each ovary (Fig. 1a) and an incidental soft tissue lesion in fundus of the gall bladder, which was considered as a gall bladder polyp (Fig. 1b). Upper GI endoscopy ruled out stomach lesions. Breast examination was normal. Our provisional diagnosis was bilateral ovarian mucinous cystadenoma. We searched for a gastrointestinal primary, but failed in detecting one. We proceeded with exploratory laparotomy. A polycystic mass of size 20 9 20 9 16 cm firm, was seen arising from right ovary and a mass of size 18 9 15 9 14 cm from left ovary. We performed total hysterectomy and bilateral oophorectomy along with tumor excision (Fig. 2). We also performed cholecystectomy (Fig. 3), infracolic omentectomy, and selective pelvic lymphadenectomy. Histopathological examination was a surprise, as it proved to be mucinous adenocarcinoma of gall bladder, and both ovarian masses were polycystic secondaries from gall bladder. Forty percent omental lymph nodes were positive for secondaries. Patient is asymptomatic with no local recurrence at 4 months of follow up.