**Question:** All the following are TRUE about Krukenberg's tumor except

A. Krukenberg's tumor is a rare type of ovarian cancer
B. It typically presents with abdominal pain and bloating
C. It is more common in young women
D. It is caused by direct extension of gastrointestinal cancer to the ovaries

**Correct Answer:** **D. It is caused by direct extension of gastrointestinal cancer to the ovaries.**

**Core Concept:**
Krukenberg's tumor is a type of ovarian cancer that occurs when malignant cells from another part of the body, typically the gastrointestinal tract, spread to the ovaries. These tumors are named after Hildegard von Krukenberg, a German pathologist who first described this entity in 1907.

**Why the Correct Answer is Right:**
Krukenberg's tumor is caused by hematogenous spread or direct extension of gastrointestinal cancers like adenocarcinomas to the ovaries. This process is known as peritoneal carcinomatosis, where cancer cells from the primary site colonize the peritoneum and ultimately the ovaries. The correct answer (D) is right because it suggests that Krukenberg's tumor is caused by direct extension of gastrointestinal cancer, which is not the typical mode of spread.

**Why Each Wrong Option is Incorrect:**

A. **Krukenberg's tumor is a rare type of ovarian cancer:** Although not as common as other ovarian cancers, Krukenberg's tumor still occurs, particularly in patients with a known primary gastrointestinal malignancy.

B. **It typically presents with abdominal pain and bloating:** While abdominal symptoms like pain, bloating, and distension are common in Krukenberg's tumor, the most specific presenting symptom is not mentioned in the question.

C. **It is more common in young women:** Krukenberg's tumor affects women of all ages, but it is more common in postmenopausal women due to a higher likelihood of associated gastrointestinal cancer in this population.

**Clinical Pearl:**
Krukenberg's tumor is often associated with peritoneal carcinomatosis, which is a common feature of advanced gastrointestinal malignancies like gastric or colorectal cancers. The presence of peritoneal carcinomatosis indicates a poor prognosis as these cancers have already advanced beyond the primary site, leading to systemic spread.

In summary, the correct answer (D) is wrong because it suggests that Krukenberg's tumor results from direct extension of gastrointestinal cancer, which is not the typical mode of spread for this condition but rather a hematogenous spread.