A 40-year-old woman presents with bilateral ovarian masses. Histology shows adenocarcinoma with signet ring cells infiltrating a fibrous ovarian stroma. Upper GI endoscopy reveals an ulcerative growth in the gastric antrum. By which route did the gastric carcinoma reach the ovaries?
- A Direct extension through the wall of the stomach
- B Transcoelomic spread via peritoneal fluid ✓
- C Lymphatic embolisation to pelvic nodes
- D Haematogenous spread through the portal vein
Correct answer: B. Transcoelomic spread via peritoneal fluid
Explanation
Krukenberg tumour is ovarian metastasis of gastric signet ring cell carcinoma, classically attributed to transcoelomic dissemination: malignant cells shed into peritoneal fluid are carried to the ovaries, which have no peritoneal covering over their surface epithelium. Haematogenous spread via the portal vein reaches liver and lung first, so it does not explain isolated bilateral ovarian deposits.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.