Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 1 2025 09 08 29 34 EN Azam Zafarbakhsh Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran. Leila Mousavi Seresht Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran. Shirin Souri Department of Obstetrics & Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Sheyda Riyahi Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran. 2025 05 24 2025 06 10 Krukenberg tumors, metastatic ovarian carcinomas primarily originating from gastrointestinal malignancies, present significant diagnostic and therapeutic challenges during pregnancy. We report a case of a 39-year-old pregnant woman initially diagnosed with autoimmune pancreatitis (AIP) and cholestasis of pregnancy, later found to have metastatic signet ring cell carcinoma of the stomach with ovarian involvement. This case highlights the complexities in differentiating malignancy from benign hepatobiliary disorders during pregnancy, emphasizing the need for a multidisciplinary approach. Early integration of tumor markers, advanced imaging, and HISORt criteria can facilitate timely diagnosis and improve clinical outcomes. https://crcp.tums.ac.ir/index.php/crcp/article/view/1052 https://crcp.tums.ac.ir/index.php/crcp/article/download/1052/708