Bilateral Krukenberg tumors due to appendiceal mucinous carcinoid

A case of mucinous carcinoid of the appendix presenting as bilateral Krukenberg tumors is reported. The patient, a 66-year-old woman, presented with vaginal spotting and lower abdominal pain of 2 months' duration. Sonography revealed a 5-cm ovarian mass. At operation a frozen section revealed metastatic mucinous carcinoid of the left ovary. Twenty months after radical surgery the patient died from abdominal carcinomatosis despite 4,500 cGy of abdominal radiation and multiagent chemotherapy. Primary ovarian carcinoid is invariably unilateral, whereas metastatic carcinoid to the ovary is almost always bilateral. The mucinous subtype appears to be more aggressive whether primary or metastatic.