Krukenberg tumor is an ovarian adenocarcinoma metastasis from a primary malignancy of the gastrointestinal tract with 76% originating from the stomach [
1]. It is bilateral in 80% of the cases [
1]. The eponym comes from the description of 5 cases by Friedrich Krukenberg (1871–1946) in 1896 [
1]. He described it as common in young women, presenting with ascites, uneven knobby ovarian surfaces, and lymphatic involvement [
1]. These characteristics are still applicable today. When a woman of reproductive age presents to the Emergency Department (ED) with abdominal, pelvic, or back pain, a urine β-human chorionic gonadotropin (β-hCG) pregnancy test is typically and appropriately part of the initial laboratory work up. If positive, the woman is presumed pregnant until proven otherwise. If an intrauterine pregnancy is ruled out, the search continues for a source of the elevated β-hCG. The differential diagnosis includes ectopic pregnancy, germ cell ovarian tumors, gestational trophoblastic neoplasia including hydatiform mole and placental site trophoblastic tumors [
2], phantom hCG resulting from interference in serum testing [
2], and paraneoplastic syndrome as a rare subset of adenocarcinomas that secrete β-hCG. Malignancies that produce β-hCG may originate from various locations such as gastric mucosa, lung, colon, cervix, and endometrial areas [
3]. A gastric origin is the most frequent, ranging from 11% to 17% of this rare subset [
3].