A woman has bilateral ovarian tumors with fibrotic, white surface nodules, ascites, and pleural effusion. Histology shows small nests of signet ring cells in a fibrotic stroma. This is most consistent with:

• A Primary high-grade serous carcinoma with peritoneal spread
• B Sertoli-Leydig cell tumor with heterologous elements
• C Endometrioid carcinoma of the ovary with squamous differentiation
• D Krukenberg tumor — metastatic signet ring cell carcinoma to the ovary ✓

Explanation

Krukenberg tumor is a metastatic mucinous carcinoma to the ovary characterized by signet ring cells (mucin-filled, displacing the nucleus peripherally) in a cellular fibromatous stroma, classically bilateral. The primary is most often gastric carcinoma (70%), but also colorectal, appendiceal, or breast primaries. Primary ovarian mucinous carcinoma rarely shows signet ring morphology, and the bilateral nature with fibrotic stroma strongly favors metastatic origin.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.