Introduction:
Krukenberg tumors are metastatic ovarian tumors, commonly originating from gastrointestinal malignancies, characterized histologically by mucin-secreting signet ring cells within the ovarian stroma. Although Krukenberg tumors are a well-recognized entity, their laparoscopic appearance and intraoperative findings are infrequently described in the literature.

Aim:
To describe the laparoscopic appearance and clinicopathologic features of Krukenberg tumor and highlight the diagnostic value of laparoscopy in such cases.

Case study:
A 22-year-old woman presented with abdominal distension and vomiting for one month. Imaging revealed bilateral adnexal masses with ascites, without an identifiable primary lesion. Diagnostic laparoscopy demonstrated asymmetrical bilateral ovarian masses with smooth, bosselated surfaces, extensive peritoneal disease, omental caking, and ascites. Frozen section of omental biopsy revealed signet ring cells in a mucinous background. Histopathology and immunohistochemistry showed tumor cells positive for CK20, CDX2, and SATB2 and negative for CK7 and PAX8, consistent with metastatic mucinous adenocarcinoma. Subsequent colonoscopy identified a descending colon primary. The patient received one cycle of chemotherapy but succumbed to disseminated disease shortly thereafter.

Results and discussion:
Krukenberg tumors commonly affect younger women and often present with nonspecific symptoms, leading to delayed diagnosis. Laparoscopy allows direct visualization of characteristic ovarian morphology, assessment of peritoneal disease, and targeted biopsies, facilitating early diagnosis and accurate staging. Immunohistochemistry plays a crucial role in differentiating metastatic gastrointestinal tumors from primary ovarian malignancies.

Conclusions:
Laparoscopy is a valuable diagnostic tool in suspected Krukenberg tumors, providing characteristic visual findings and enabling timely histological confirmation. Awareness of their laparoscopic appearance may aid in early diagnosis and appropriate management of this aggressive disease.