WBR0169
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| 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 complaining of abdominal distention. Following appropriate work-up, the patient is found to have a metastatic bilateral ovarian tumor obstructing the lymphatic drainage with subsequent ascites. Pathological analysis of the ovarian tumor shows signet ring cell adenocarcinoma consistent with the diagnosis. What is the most appropriate next step in management?]] |
| Answer A | AnswerA::Gastroscopy |
| Answer A Explanation | AnswerAExp::Most Krukenberg tumors arise from 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 a primary site of malignancy is indicated in Krukenberg tumor. |
| Answer C | AnswerC::Brain MRI |
| Answer C Explanation | AnswerCExp::Brain MRI is not indicated in Krukenberg tumor if no clinical suspicion of brain involvement is found. |
| Answer D | AnswerD::Lumbar puncture |
| Answer D Explanation | AnswerDExp::Lumbar puncture is not helpful. |
| Answer E | AnswerE::Bronchoscopy |
| Answer E Explanation | AnswerEExp::Bronchoscopy is not indicated once Krukenberg tumor is diagnosed with no suspicion of pulmonary involvement. |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::The patient is most likely diagnosed with Krukenberg tumor. It is characterized by epithelial and stromal mass, whose epithelial component contains mucin-laden signet ring cells with hyperchromatic nuclei and eosinophilic granular cytoplasm. It usually appears as a bilateral tumor with signs of lymphatic obstruction. Krukenberg tumor are often diagnosed in patients in their fifth decade. The most common primary site of malignancy is the stomach, warranting radiographic and endoscopic evaluation of the digestive system once the diagnosis is made.
Educational Objective: The stomach is the most common primary site of Krukenberg tumor. Work-up to rule out GI involvement is indicated once the diagnosis is made. Reference:
Al-Agha OM, Nicastri AD. An in-depth look at krukenberg tumor - an overview. Arch Pathol Lab Med. 2006;130:1725-30 |
| Approved | Approved::No |
| Keyword | WBRKeyword::krukenberg, WBRKeyword::tumor, WBRKeyword::ovarian, WBRKeyword::mass, WBRKeyword::malignant, WBRKeyword::malignancy, WBRKeyword::cancer, WBRKeyword::stomach, WBRKeyword::gastroscopy, WBRKeyword::work, WBRKeyword::up, WBRKeyword::endoscopy, WBRKeyword::management, WBRKeyword::next, WBRKeyword::step, WBRKeyword::ascites, WBRKeyword::abdominal, WBRKeyword::distention |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |