Renata Miranda Echevarria
Centro Medico ABC, Mexico City
Abstract Title:
Aggressive Stage IV Colorectal Adenocarcinoma Presenting as Bilateral Krukenberg Tumors in a 15-Year-Old
Biography:
Renata Miranda Echevarria, M.D., is a General Surgery Resident at Hospital ABC, a leading medical institution in Mexico. She earned her medical degree from Universidad Anáhuac Querétaro. Currently, she is also pursuing a Master's degree in Research from Universidad Anáhuac México. Dr. Miranda Echevarria maintains a strong clinical and research focus, particularly in the fields of Pediatric Surgery and complex oncological pathology. Her commitment to contributing to surgical literature is highlighted by this presentation on an exceptionally rare case.
Research Interests:
Krukenberg tumors are metastatic ovarian adenocarcinomas originating from the gastrointestinal tract, typically the stomach (76%) or, less commonly, the colorectum (11%). Histologically, they are characterized by mucin-rich signet ring cells invading the ovarian stroma. While immunohistochemistry is vital for distinguishing them from primary ovarian neoplasms, the diagnosis remains challenging. The median age of diagnosis is 45 years; consequently, presentation in adolescence is extremely rare. We present the case of a previously healthy 15-year-old female admitted with a 4-week history of progressive abdominal pain, severe constipation, and ascites. Following imaging suggestive of bilateral solid adnexal masses with peritoneal carcinomatosis and elevated tumor markers (CEA 111.48, CA-125 259.2, CA 19-9 265.2), the patient underwent an exploratory laparotomy that revealed a primary tumor in the sigmoid colon with bilateral ovarian metastases and extensive peritoneal seeding. The surgical intervention consisted of a sigmoidectomy with end colostomy, resection of bilateral Krukenberg tumors, omentectomy, and appendectomy. Final histopathology confirmed a poorly differentiated (G3) mucinous adenocarcinoma of the sigmoid colon with a significant signet ring cell component (40%), showing extensive lymphovascular invasion and metastasis to both ovaries, omentum, peritoneum, and 26 regional lymph nodes (pT4b pN2b pM1c); immunohistochemistry confirmed a colorectal origin (SATB2 positive, PAX8 negative) with intact mismatch repair proteins (pMMR) and negative HER2 status. The patient showed an adequate postoperative evolution, and the current plan includes the placement of a port-a-cath and the initiation of a chemotherapy and radiotherapy protocol.
