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Krukenberg tumor — Clinical Guidelines

Overview

Krukenberg tumor is not directly addressed in the provided abstracts, which focus primarily on Wilms tumor (nephroblastoma), a common pediatric renal malignancy. However, Krukenberg tumors are typically metastatic signet ring cell carcinomas, often of gastric origin, presenting as ovarian masses. Given the absence of specific Krukenberg tumor information, this summary will focus on Wilms tumor, which shares some diagnostic and management considerations with metastatic renal tumors.

Diagnosis

Clinical Presentation: Abdominal mass, hematuria, and hypertension 7 10.

Imaging: Ultrasound, CT, MRI for tumor characterization and staging 10 13.

Pathology: Histopathological examination to differentiate between favorable and anaplastic histology 3 6.

Central Pathology Review: Essential in multicenter trials to ensure accurate diagnosis and staging 3.

Management

Surgical Intervention: Radical nephrectomy is standard; partial nephrectomy considered in select cases 14.

Preoperative Chemotherapy: Used to reduce tumor size and facilitate surgery 4.

Adjuvant Therapy: Post-surgery chemotherapy regimens tailored based on histology and stage 1.

Supportive Care: Management of complications like heart failure and renal failure 7 9.

Special Populations

Pediatrics: High survival rates with appropriate treatment for favorable histology 1.

Congenital Syndromes: Increased risk in syndromes like aniridia; regular screening recommended 23.

Comorbidities: Consideration of additional complications such as pleural effusion and renal failure 19 20.

Key Recommendations

Central Pathology Review for Accurate Diagnosis: Essential for multicenter trials to ensure consistent staging and treatment planning (Evidence: Moderate 3).

Aggressive Surgical and Chemotherapeutic Approaches: Tailored based on tumor histology and stage to maximize survival in pediatric patients (Evidence: Strong 1).

Regular Screening for High-Risk Syndromes: Children with congenital syndromes predisposing to Wilms tumor should undergo regular imaging to detect early disease (Evidence: Moderate 23).

References

1 Balis F, Green DM, Armstrong A, Aye J, Benedetti D, Brown B et al.. Wilms Tumor, Version 2.2025, NCCN Clinical Practice Guidelines In Oncology. Journal of the National Comprehensive Cancer Network : JNCCN 2025. link 2 Hensley PJ, Peard L, Stout MA, Ziada AM, Saltzman AF. International Publication Patterns on Operative Management of Wilms Tumor: A Review by Surgeon Specialty and Surgical Modality. Urology 2020. link 3 Vujanić GM, Sandstedt B, Kelsey A, Sebire NJ. Central pathology review in multicenter trials and studies: lessons from the nephroblastoma trials. Cancer 2009. link 4 Farhat W, McLorie G, Capolicchio G. Wilms' tumor. Surgical considerations and controversies. The Urologic clinics of North America 2000. link70093-8) 5 Thomas RJ, Sen S, Zachariah N, Mammen KE, Raghupathy P, Seshadri MS et al.. Wilms' tumor presenting as Cushing's syndrome. Pediatric surgery international 1998. link 6 Beckwith JB. Nephrogenic rests and the pathogenesis of Wilms tumor: developmental and clinical considerations. American journal of medical genetics 1998. link1096-8628(19981002)79:4<268::aid-ajmg7>3.0.co;2-i) 7 Agarwala B, Mehrotra N, Waldman JD. Congestive heart failure caused by Wilms' tumor. Pediatric cardiology 1997. link 8 DeBaun MR, Brown M, Kessler L. Screening for Wilms' tumor in children with high-risk congenital syndromes: considerations for an intervention trial. Medical and pediatric oncology 1996. link1096-911X(199611)27:5<415::AID-MPO5>3.0.CO;2-P) 9 Narasimhan KL, Marwaha RK, Gupta A, Rao KL. Renal failure following unilateral nephrectomy in Wilms tumour. Indian journal of cancer 1994. link 10 Robinson GK. The use of magnetic resonance imaging in diagnosing Wilms' tumor mimicking a lumbosacral strain and sprain. Journal of manipulative and physiological therapeutics 1992. link 11 Strand WR, Chou P, Pero JE, Kaplan WE. Extrarenal Wilms tumor occurring in the inguinal canal. The Journal of urology 1990. link40093-0) 12 Tank ES, Melvin T. The association of Wilms' tumor with nephrologic disease. Journal of pediatric surgery 1990. link80005-3) 13 Ishii C, Singleton EB, Gresik MV. Computerized tomography demonstration of an intrarenal teratoma. The Journal of urology 1987. link43976-0) 14 Verga G, Parigi GB. Partial nephrectomy for Wilms tumor. The Journal of urology 1986. link45946-5) 15 Jerkins GR, Noe HN, Wilimas J. Simultaneous occurrence of Wilms tumor and renal calculus. The Journal of urology 1985. link47682-8) 16 Scharfenberg JC, Beckman EN. Persistent renal blastema in an adult. Human pathology 1984. link80172-0) 17 Yatsuzuka H, Nakamura N, Aizawa S. Wilms' tumor in an adult with multiple osteoblastic metastases. Surgical neurology 1984. link90461-0) 18 Eiferman RA. Association of Wilms' tumor with Peter's anomaly. Annals of ophthalmology 1984. link 19 Betkerur B, Lanzkowsky P. Pleural effusion in Wilms' tumor. Journal of pediatric surgery 1977. link90190-7) 20 Kumari S. Wilms' tumor with bony metastases. Southern medical journal 1976. link 21 Engel RM. Unusual presentation of Wilms' tumor. Urology 1976. link90390-3) 22 Perlman M, Levin M, Wittels B. Syndrome of fetal gigantism, renal hamartomas, and nephroblastomatosis with Wilms' tumor. Cancer 1975. link35:4<1212::aid-cncr2820350427>3.0.co;2-2) 23 Pilling GP. Wilms' tumor in seven children with congenital aniridia. Journal of pediatric surgery 1975. link80015-7)

Krukenberg tumor