WBR0169
| Author | [[PageAuthor::Yazan Daaboul, M.D.(Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Oncology |
| Prompt | [[Prompt::A 54-year-old woman presents to the physician's office with complaints of abdominal distention. Following appropriate work-up, the patient is found to have a bilateral metastatic ovarian tumor obstructing the lymphatic drainage, with subsequent ascites. Upon pathological analysis of the ovarian tumor you observe signet ring cell adenocarcinoma consistent with the diagnosis. Which of the following is the most appropriate next step in management?]] |
| Answer A | AnswerA::Gastroscopy |
| Answer A Explanation | [[AnswerAExp::Most Krukenberg tumors originate in the stomach, thus necessitating radiographic and endoscopic work-up of the digestive system.]] |
| Answer B | AnswerB::Observation with annual check-up |
| Answer B Explanation | [[AnswerBExp::Evaluation of the primary site of malignancy is indicated in Krukenberg tumors, which often originate in the stomach.]] |
| Answer C | AnswerC::Brain MRI |
| Answer C Explanation | [[AnswerCExp::A brain MRI is not necessary upon diagnosis of a Krukenberg tumor if no clinical suspicion of brain involvement is found.]] |
| Answer D | AnswerD::Lumbar puncture |
| Answer D Explanation | [[AnswerDExp::Lumbar punctures usually are not necessary, because Krukenberg tumors often originate in the stomach.]] |
| Answer E | AnswerE::Bronchoscopy |
| Answer E Explanation | [[AnswerEExp::A bronchoscopy is not necessary upon diagnosis of a Krukenberg tumor, which often originate in the stomach.]] |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::The patient in this scenario is most likely diagnosed with a Krukenberg tumor. A Krukenberg tumor is characterized by the presence of an epithelial and stromal mass, with an epithelial component containing mucin-laden signet ring cells, which have hyperchromatic nuclei and eosinophilic granular cytoplasm. A Krukenberg tumor usually appears as bilateral with signs of lymphatic obstruction. Krukenberg tumors are often diagnosed in patients who are in their 50s. The most common primary site of malignancy is the stomach, warranting radiographic and endoscopic evaluation of the digestive system following diagnosis. Educational Objective: The stomach is the most common primary site of Krukenberg tumors. Work-up to rule out GI involvement is indicated upon diagnosis. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::krukenberg, WBRKeyword::tumor, WBRKeyword::ovarian, WBRKeyword::mass, WBRKeyword::malignant, WBRKeyword::cancer, WBRKeyword::stomach, WBRKeyword::gastroscopy, WBRKeyword::endoscopy, WBRKeyword::management, WBRKeyword::abdominal |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |