<unk>   is a rare metastatic signet ring cell adenocarcinoma of the ovary.<unk>  was first described as a new type of primary ovarian malignancy by Friedrich Ernst<unk>  (1871–1946), a German gynecologist and pathologist, in 1896 which was later confirmed to be of metastatic gastrointestinal tract origin. The pathogenesis of<unk> s involves metastasis of<unk>  cells from the stomach, appendix or colon to the ovaries. Metastasis is more likely via the lymphatic spread. However, direct seeding across the abdominal cavity may also occur. On gross pathology, asymmetrically enlarged ovaries with a bosselated contour, usually solid, yellow or white cross sectioned surfaces, and the absence of adhesions or peritoneal deposits are characteristic findings of<unk> s.<unk>  must be differentiated from primary mucinous carcinoma, mucinous carcinoid<unk> , signet ring stromal<unk> , sclerosing stromal cell<unk> , clear cell adenocarcinoma of the ovary, and Sertoli-Leydig cell<unk> . The incidence of<unk> s is estimated to be approximately 0.16 per 100,000 individuals.<unk>  is more commonly observed among women in their fifth decade of lives, with an average around 45 years of age. The majority of patients with<unk>  remain asymptomatic or have non-specific gastrointestinal symptoms. Early clinical features include abdominal pain and distension (from the large, bilateral ovarian masses). If left untreated, patients with<unk> s may progress to develop virilization from the excessive hormone production from the ovarian stroma. Prognosis is generally poor, and the 5 ­year survival rate of patients with<unk>  is lower in patients in with a preoperative serum CA-125 levels greater than 75 U/mL when compared with patients with CA-125 levels less than 75 U/mL. The median survival of patients is between 7 to 14 months. X rays, ultrasound, CT, MRI and immunohistochemistry help in the diagnosis of<unk> s. Management of<unk> s is driven by the identification and treatment of the primary cancer. Bilateral oophorectomy may only be performed for patients where the metastasis is localized to the ovaries. The significance of early detection of ovarian metastasis and the importance of monitoring serum CA-125 level may improve the prognosis. Surgical resection may not be an option if the<unk>  has already metastasized to other sites.
Krukenberg tumor
Thecoma
Sebaceoma
Littoral cell angioma
Ganglion cyst
Cementoblastoma
Pilomatricoma
Syringoma