A 48-year-old woman presents with bilateral ovarian masses. Histology shows ovaries infiltrated by signet-ring cells containing intracytoplasmic mucin. Further evaluation reveals a diffusely thickened stomach with loss of rugal folds. The route of spread from the stomach to the ovaries in this condition is:
- A Direct invasion through the gastrocolic ligament
- B Lymphatic embolization to para-aortic nodes and then retrograde ovarian lymphatics
- C Transcoelomic seeding of malignant cells across the peritoneal cavity ✓
- D Haematogenous spread via the portal vein to the liver and then the ovaries
Explanation
Krukenberg tumours are ovarian metastases, classically from a diffuse-type gastric carcinoma with signet-ring cells. Spread occurs by transcoelomic dissemination, where malignant cells exfoliate from the serosal surface of the stomach and implant on the ovarian surface and peritoneum. Diffuse gastric cancers frequently penetrate the serosa early, favouring this route. Haematogenous spread goes chiefly to liver, lung, and bone, while lymphatic spread explains nodes such as Virchow and the periumbilical Sister Mary Joseph nodule, not the typical ovarian deposit pattern.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.