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Most patients with Krukenberg tumor are older; rarely, it can affect younger patients. Some cases show marked stromal proliferation, stromal luteinization, and even virilization. Such cases may be misdiagnosed as Sertoli-Leydig cell tumor, if the signet ring cells are not prominent. In some cases, the extraovarian primary tumor remains occult and is not found even after careful search. Mucicarmine stain and immunohistochemical stains for epithelial markers are recommended to confirm the diagnosis of Krukenberg tumor. Courtesy of : Ed Uthman, MD, Houston, Texas.