A 41-year-old woman presents with bilateral ovarian masses. Histology shows adenocarcinoma containing signet ring cells staining positive for cytokeratin 20. Upper GI endoscopy reveals an ulcerative gastric carcinoma. By which route did the tumour reach the ovaries?
- A Transcoelomic spread across the peritoneal cavity ✓
- B Lymphatic embolisation via para-aortic nodes
- C Portal venous metastasis to liver then ovary
- D Direct contiguous invasion through the broad ligament
Correct answer: A. Transcoelomic spread across the peritoneal cavity
Explanation
Krukenberg tumours arise when gastric carcinoma, classically diffuse signet ring type, seeds the ovaries by transcoelomic spread through the peritoneal fluid, aided by the negative intra-abdominal pressure over the ovaries. Haematogenous spread goes first to liver and lung, and direct invasion requires contiguous pelvic disease, neither of which fits bilateral ovarian deposits from a gastric primary.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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