With the above radiological features, Krukenberg tumor of the ovaries of gastric origin was on top of the differential diagnosis. However, with the hepatosplenomgaly, the deep cervical and abdominal lymphadenopathy and the stromal nature of the ovarian masses, lymphoma had to be considered.

Fine needle aspiration cytology was taken from the cervical lymph nodes. Aspiration cytology of the ascitic fluid was also done.

The lymph node smear was positive for malignant epithelial cells with signet ring forms (metastatic carcinomatous deposits). Ascitic fluid showed florid reactive mesothelial irritation with highly atypical cells, suspiscious for malignant epithelial cells.

This, along with the significantly elevated CEA and CA 19-9 tumor markers, favored the diagnosis of Krukenberg over lymphoma. The lady was referred to oncology; however endoscopic assessment of the stomach was deferred since she was unfit for invasive interventions.