A 60-year-old presents with bilateral ovarian masses, ascites, and a normal CA-125 but elevated CEA and CA 19-9. Endoscopy reveals a gastric antral adenocarcinoma. The ovarian masses are most likely:
- A Primary bilateral mucinous cystadenomas
- B Primary high-grade serous carcinoma
- C Krukenberg tumors (metastatic signet-ring cell carcinoma) ✓
- D Sex cord-stromal tumors
Correct answer: C. Krukenberg tumors (metastatic signet-ring cell carcinoma)
Explanation
Krukenberg tumor is a metastatic carcinoma to the ovary, most commonly originating from the stomach (especially signet-ring cell gastric carcinoma), followed by colorectal, breast, and biliary primaries. Characteristically bilateral, they contain mucin-secreting signet-ring cells within a cellular stroma. CEA and CA 19-9 elevation with normal CA-125 in bilateral ovarian masses with a gastric primary is the classic Krukenberg scenario. Primary mucinous ovarian tumors are typically unilateral; bilateral mucinous ovarian tumors should prompt investigation for a GI primary.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.