A woman with advanced ovarian carcinoma has massive ascites with peritoneal seedling deposits over the omentum and parietal peritoneum, but no parenchymal liver metastasis. This pattern of dissemination is characteristic of which route of tumour spread?

• A Haematogenous spread
• B Lymphatic permeation
• C Retrograde venous spread via Batson's plexus
• D Transcoelomic spread across the peritoneal cavity ✓

Explanation

Ovarian cancer characteristically sheds malignant cells into the peritoneal fluid, which then implant on peritoneal and omental surfaces, producing seedlings and pseudomyxoma-like deposits without distant parenchymal metastases early in the disease. This transcoelomic route also spreads gastric carcinoma to Krukenberg deposits in the ovaries, a fact worth knowing. Batson's plexus explains vertebral metastasis from prostate cancer, a different pattern altogether.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.