A 68-year-old presents with bilateral solid-cystic ovarian masses (8 cm each) and a pelvic mass. Serum CA-125 is 2,400 U/mL and CEA is 58 ng/mL. Histology shows signet-ring cells infiltrating a cellular fibrous stroma. Which is the correct diagnosis and its most likely primary site?
- A Krukenberg tumour; primary most likely in the colon
- B Krukenberg tumour; primary most likely in the stomach ✓
- C Primary ovarian mucinous carcinoma
- D Clear cell carcinoma of ovary
Correct answer: B. Krukenberg tumour; primary most likely in the stomach
Explanation
Krukenberg tumour is a metastatic mucin-secreting carcinoma in the ovary characterised by signet-ring cells (cells with cytoplasmic mucin displacing the nucleus) embedded in a cellular stromal reaction (pseudosarcomatous stroma). The most common primary site is the stomach (76% of cases), followed by colorectum, appendix, breast, and biliary tract. The elevated CEA supports a gastrointestinal primary. Bilateral involvement is present in > 80% of Krukenberg tumours. Primary mucinous ovarian carcinoma does not show signet-ring cell pattern with a cellular fibrous stroma.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.