Bilateral Ovarian Metastases from Gastric Signet-Ring Cell Carcinoma in an 18-Year-Old: A Case Report and Narrative Review

Andreea Boiangiu^1,2Liviu Bilteanu^3,4,5*Andreea Costeschi²Catalina-Andreea Nicolae²Romina-Marina Sima¹Radu Vladareanu^1,2Andreea Iren Serban^4,6Serban Andrei Marinescu¹Valentin Varlas¹Cezar Angi Iliescu⁷Alexandru Filipescu^1,2

• ¹Universitatea de Medicina si Farmacie Carol Davila din Bucuresti Facultatea de Medicina, Bucharest, Romania
• ²Spitalul Universitar de Urgenta Elias, Bucharest, Romania
• ³Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
• ⁴Universitatea din Bucuresti Facultatea de Biologie, Bucharest, Romania
• ⁵Institutul National de Cercetare Dezvoltare Pentru Microtehnologie, Bucharest, Romania
• ⁶Universitatea de Stiinte Agronomice si Medicina Veterinara din Bucuresti Facultatea De Medicina Veterinara, Bucharest, Romania
• ⁷The University of Texas MD Anderson Cancer Center, Houston, United States

Background/Objectives: Krukenberg tumors (KTs) are rare metastatic ovarian neoplasms, most frequently secondary to gastric adenocarcinomas, and typically occur in women aged 30–60 years. Their presentation in adolescents is exceedingly uncommon and often leads to diagnostic delays due to nonspecific symptoms and low clinical suspicion. Case presentation: We describe the case of an 18-year-old female presenting with progressive abdominal pain and bilateral adnexal masses. Imaging suggested advanced ovarian pathology, and surgical exploration with histopathological evaluation confirmed metastatic signet-ring cell carcinoma. Upper gastrointestinal endoscopy subsequently identified a poorly differentiated gastric adenocarcinoma, establishing the diagnosis of KT. Methods: To place this case in context, a narrative literature review was performed using PubMed, Google Scholar, and ScienceDirect. English-language case reports and case series describing KTs in patients aged ≤20 years were selected. Fifteen studies were analyzed regarding clinical presentation, histopathological features, diagnostic approach, and patient outcomes. Results: The majority of reported cases demonstrated bilateral ovarian involvement, vague abdominal This is a provisional file, not the final typeset article symptoms, and gastric origin. Diagnostic delays were frequent, and prognosis remained poor despite multimodal treatment strategies. Conclusions: This case highlights the importance of considering metastatic gastrointestinal malignancies in the differential diagnosis of ovarian tumors in adolescents and emphasizes the value of early endoscopic assessment. By combining a rare adolescent case with a focused literature review, this work provides one of the few comprehensive syntheses of KTs in patients under 20 years, offering a unique contribution to improving clinical awareness and guiding future diagnostic strategies.