Bilateral ovarian metastases from gastric signet-ring cell carcinoma in an 18-year-old: a case report and narrative review

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 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.