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

A. It is a rare type of ovarian cancer that arises from the fallopian tube.
B. It is usually diagnosed in early stage due to asymptomatic presentation.
C. It is primarily a disease of children.
D. It is always caused by a primary peritoneal cancer.

**Correct Answer:** D. It is always caused by a primary peritoneal cancer.

**Core Concept:** Krukenberg's tumor is a type of ovarian cancer that often occurs in women due to the spread of cancer cells from the gastrointestinal tract or other primary sites. This tumor is named after Hildegard von Bingen, who first described it in 1896.

**Why the Correct Answer is Right:** Krukenberg's tumor is not always caused by a primary peritoneal cancer. While it can arise from the fallopian tube, it is also known to arise from various other primary sites, such as the stomach, colon, pancreas, or breast. In these cases, the cancer cells from these primary sites could spread to the ovaries and form Krukenberg's tumor.

**Why Each Wrong Option is Incorrect:**

A. Krukenberg's tumor is a rare type of ovarian cancer, but its etiology is not limited to the fallopian tube alone.
B. The tumor's asymptomatic presentation does not mean it is always diagnosed in early stage. In fact, the tumor is often diagnosed during advanced stages due to nonspecific symptoms or an incidental finding during surgery.
C. Krukenberg's tumor is not primarily a disease of children; it typically occurs in women of reproductive age.

**Clinical Pearl:**

Krukenberg's tumor is a critical differential diagnosis to keep in mind when assessing ovarian masses, especially when patients present with nonspecific symptoms or during surgery. Understanding the potential primary sites and clinical presentation of the tumor can help guide further diagnostic and therapeutic decisions.