Metastases to the ovary
- Lesion
Not every ovarian cancer starts in the ovary: stomach, bowel and breast cancers often land there, usually on both sides.
What it is
Metastases account for a meaningful share of malignant ovarian tumours and are easily mistaken for primaries. The commonest sources are the gastrointestinal tract (colon, stomach, appendix, pancreas and biliary tract), the breast (especially lobular carcinoma), and other Müllerian sites such as the endometrium. The Krukenberg tumour is a bilateral metastasis of signet-ring cells in a cellular stroma, classically from diffuse gastric cancer. Recognising a metastasis changes the treatment entirely.
Structure
- Krukenberg: firm, bosselated ovaries with a solid cut surface; signet-ring cells singly or in clusters, sometimes with oedematous stroma.
- Colorectal: glands with central necrotic debris (garland pattern) that resemble endometrioid carcinoma.
- Lobular breast carcinoma: single files and cords of small cells, often signet-ring forms.
Step by step
- Cancer cells leave the primary tumour through the peritoneum, lymphatics or blood.
- The ovary, with a rich blood supply and a surface exposed to peritoneal fluid, receives the cells.
- The cells grow as surface implants and nodules, often in both ovaries.
- The ovarian stroma reacts and can even become luteinised and hormonally active.
Markers
- CK7 and CK20 pattern
- SATB2 and CDX2 (intestinal)
- GATA3 (breast)
- PAX8 (Müllerian primary)
Clinical notes
- The ovarian mass may be found before the primary; a gastric or colorectal cancer search is part of the work-up of bilateral mucinous or signet-ring tumours.
- In Colombia, where gastric cancer is frequent, Krukenberg tumours are a real diagnostic consideration in women with bilateral ovarian masses.
Test yourself
Think of the answer, then tap the question to see it.
What is a Krukenberg tumour?
A metastasis to the ovaries, usually bilateral, made of mucin-filled signet-ring cells, most often from diffuse gastric carcinoma.
Which features suggest an ovarian tumour is metastatic?
Bilaterality, small size, surface involvement, multinodular growth and lymphovascular invasion.
Which immunostain pattern points to a colorectal origin?
CK20 and SATB2 positive with CK7 negative.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Epithelial Ovarian Cancer (StatPearls (NCBI Bookshelf), 2026); Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®)–Health Professional Version (National Cancer Institute, 2026).
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Representative model, for educational purposes only.