Anahat Kaur MD¹, Bhanujit Dwivedi MBBS^2,, Angad Singh MD³, Tejasvi Dwivedi MBBS⁴, Rubina Sharma MD⁵, Sherrie White MD⁶

Adenocarcinoma of the small intestine is one of the most uncommon gastrointestinal malignancies, comprising <5% of all GI cancers. Krukenberg tumors are also uncommon, making up only 3-5% of ovarian malignancies. We are reporting a rare case of a patient with small bowel adenocarcinoma presenting with Krukenberg metastasis. A 79-year-old female initially presented with abdominal pain and diarrhea and was found to have a long segment of irregularly thickened distal ileum suspicious for malignancy. The patient was unable to maintain consistent follow-up for almost a year after which she presented with early satiety, abdominal bloating, palpable abdominal mass and 20 lb weight loss. US and CTAP now revealed a large complex cystic mass in the pelvis with persistent bowel wall thickening and elevated CA- 125 tumor marker. The site of origin could not be determined on FNA biopsy so the patient underwent surgical resection with pathology showing adenocarcinoma of the ileum with metastatic involvement of the right ovary (Krukenberg metastasis). Molecular somatic mutation testing showed microsatellite instability (MSI-High status). She completed 12 cycles of consolidative chemotherapy with FOLFOX and currently remains in remission on pembrolizumab maintenance.This case highlights the rarity of presentation, diagnostic challenges and successful treatment of patients with ileal adenocarcinoma presenting with Krukenberg metastasis.

Ileal adenocarcinoma, Krukenberg metastasis, Debulking surgery, Immune checkpoint inhibitor