# Krukenberg Tumour

> Krukenberg tumour with signet ring cells, gastric primary search and bilateral metastatic ovarian disease, for NEET-PG Obstetrics and Gynaecology.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/krukenberg-tumour
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: Williams Gynecology; Robbins Basic Pathology; Shaw's Textbook of Gynaecology
- How to cite: "Krukenberg Tumour", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/krukenberg-tumour

## Direct answer

Krukenberg tumour is a bilateral ovarian metastasis of signet ring cell adenocarcinoma, most often arising from a gastric primary. It typically affects middle-aged women with bilateral solid ovarian masses, ascites and abdominal pain. Diagnosis is confirmed by histology, and the priority is finding the gastrointestinal primary, because the ovarian disease is usually palliative.

## What you must remember

- **Definition:** a metastatic ovarian tumour made of signet ring cells, with mucin-filled cytoplasm pushing the nucleus to one side.
- **Commonest primary:** the stomach, with other sources including colon, breast and pancreas.
- **Appearance:** bilateral, solid, firm ovarian masses, often kidney-shaped, usually with ascites.
- **Stroma:** signet ring cells infiltrate a cellular ovarian stroma, which distinguishes the lesion from a primary mucinous tumour.
- **Presentation:** pain, distension and weight loss, sometimes with dyspepsia or symptoms of the primary.
- **Markers:** CA-125 and CEA are often raised, but neither is specific for the origin.
- **Primary search:** upper gastrointestinal endoscopy with biopsy is the key first investigation.
- **Prognosis:** generally poor, so treatment aims at the primary and at symptom control.

## Working up a bilateral solid ovarian mass

A bilateral solid ovarian mass in an older woman should prompt a search for a primary before any ovarian surgery. Ovarian surgery at this stage rarely helps and may delay the diagnosis.

1. **Recognise the pattern:** Bilateral solid ovarian masses with ascites suggest metastasis rather than a primary ovarian cancer.
2. **Confirm histology:** The ovarian biopsy or specimen shows signet ring cells within a cellular stroma.
3. **Search the gut:** Upper gastrointestinal endoscopy with biopsy is the key test, with colonoscopy added if the primary is not gastric. Repeat biopsies are needed if the first sample is non-diagnostic.
4. **Image the body:** CT of the chest and abdomen defines the extent of spread, and breast assessment is considered when lobular carcinoma is possible. Liver and peritoneal disease on CT shapes palliative planning.
5. **Use immunohistochemistry:** Panels help support a gastrointestinal or breast origin, but results must be read alongside the histology. Panels are best interpreted together rather than stain by stain.
6. **Plan palliation:** Treatment of the primary and symptom control guide management, since surgery rarely changes the outcome. Early referral to palliative care is usually appropriate.

## Krukenberg traps

Krukenberg questions reward recognising a metastasis disguised as a primary ovarian tumour.

- **Trap:** Staging a bilateral ovarian mass as primary ovarian cancer and planning debulking — **Correct:** metastasis is suspected first, and the primary must be found.
- **Trap:** Using CA-125 to confirm an ovarian primary — **Correct:** CA-125 is nonspecific and cannot separate primary from metastatic disease.
- **Trap:** Assuming the stomach is always the source — **Correct:** colon, breast and pancreas also cause ovarian metastasis, so a broad search is needed.
- **Trap:** Treating a signet ring finding as diagnostic of gastric cancer alone — **Correct:** histology and immunohistochemistry are needed to confirm the origin.

## Frequently asked questions

### What is a Krukenberg tumour?

A Krukenberg tumour is a bilateral ovarian metastasis of signet ring cell adenocarcinoma, most often from a gastric primary. It is a metastasis rather than a primary ovarian cancer, and it is usually found in middle-aged women with bilateral solid ovarian masses.

### What histological feature defines a Krukenberg tumour?

A Krukenberg tumour is defined by signet ring cells, which have mucin-filled cytoplasm pushing the nucleus to the periphery, infiltrating a cellular ovarian stroma. Histology confirms the diagnosis, and immunohistochemistry helps identify the likely primary site.

### Which investigation should follow an ovarian signet ring cell metastasis?

Upper gastrointestinal endoscopy with biopsy is the key first investigation, because the stomach is the commonest primary. Colonoscopy, CT of the chest and abdomen and breast assessment are added when the primary is not identified.

### Is surgery curative for a Krukenberg tumour?

Surgery is not curative for a Krukenberg tumour, because it represents widespread metastatic disease. Treatment is directed at the gastrointestinal primary, with surgery generally limited to symptom relief or specific indications.