Sixty-three-year-old nulliparous patient, presenting with second relapse of epithelial ovarian cancer diagnosed by the increasing level of serum tumor markers with negative radiological studies.\nThe patient was diagnosed with epithelial ovarian cancer 7 years ago, when she underwent surgical resection (Wertheim-Meigs surgery), associated with adjuvant chemotherapy using cisplatin/paclitaxel (CP), presenting complete clinical remission, with the absence of signs and symptoms, normal levels of CA-125 and negative PET-CT.\nFive years ago, she developed the peritoneal relapse, and was treated with neoadjuvant chemotherapy with CP, peritonectomy with hyperthermic intraperitoneal chemotherapy, followed by adjuvant chemotherapy with the same drugs, once again, presenting complete clinical remission.\nOne year ago, she presented with an increase in CA-125 serum level for 3 months. On this occasion, she had a PET-CT, which showed the densification of peritoneal fat in the lower abdomen with fibro-cicatricial characteristics, unchanged in comparison to the previous examinations, besides showing heterogeneous parietal gastric thickening associated with the densification of the surrounding fat planes. There was no evidence of abnormal contrast enhancement []. The upper digestive echo-endoscopy showed unspecific parietal gastric thickening, a small slide with perihepatic ascites and three oval-shaped hypo-echogenic and heterogeneous formations with septations and anechoic content, measuring around 10 mm [], located between the hepatic hilum and the peripancreatic cephalic region that were punctured with 22-gauge needle.\nHistologic study confirmed the diagnosis of metastatic serous cystadenocarcinoma, the immunohistochemical study indicated the gynecological tract as the primary site []. It was not possible to determine accurately whether the injury observed in endoscopic ultrasound (EUS) were tumor implants or lymph node recurrence.\nAfter the diagnosis of a second relapse, the patient underwent chemotherapy with CP, but did not show significant improvement. Due to resistance to platinum-based chemotherapy, she switched to bevacizumab and liposomal doxorubicin therapy, with good response, presenting, once again, complete clinical remission. Nowadays, the patient's clinical exams are normal. CA-125 serum levels been normal and the upper digestive echo-endoscopy confirmed regression of the previously identified lesions.
In January 2014, a 58-year-old woman was admitted to our department with a gastric submucosal tumor that was recently discovered during a routine checkup and gastroduodenoscopy. She did not complain of any symptoms. Her medical history showed that she had undergone a total thyroidectomy due to thyroid cancer in 2009, as well as wide excision and radiation treatment for ductal carcinoma in situ of the breast in 2013.\nMore relevant to the present case, the patient was diagnosed with ovarian serous adenocarcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage IIIB) in 2011. She underwent a total hysterectomy with salpingo-oophorectomy and pelvic and paraaortic lymph node dissection with total omentectomy, followed by 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel. In 2012, the patient was re-examined and found to have newly developed seeding metastases in the perihepatic space, omentum, perirectal area, diaphragm, and external iliac chain. Her CA-125 level had increased to 51.06 U/ml. Following a debulking operation, she received 9 additional cycles of adjuvant chemotherapy with the previously described regimen. Subsequently, the CA-125 levels were tested every 3 months. After the additional chemotherapy, it had decreased to the normal range and a radiologic examination revealed tumor regression.\nThe gastric submucosal tumor found in January 2014 was a 2 cm low-echogenic lesion located on the greater curvature of the antrum and showed irregularity in the propria muscle layer (). The pathological diagnosis from the endoscopic biopsy before the operation was chronic active gastritis.\nA computed tomography (CT) scan indicated focal thickening and the formation of a mass in the greater curvature of the gastric body, as well as multiple enlarged lymph nodes along the greater curvature of the stomach ().\nWe considered several possible diagnoses, such as metastatic lesions deriving from the ovary or breast. The patient subsequently underwent curative subtotal gastrectomy with lymphadenectomy. During the operation, multiple enlarged lymph nodes were found to be conglomerated with the stomach, but no other recurrent tumors were found. Frozen section biopsy revealed that the lymph nodes were malignant. Macroscopically, a 3.5×3.0 cm submucosal tumor with ulceration was located in the stomach (). Microscopically, infiltration of metastatic serous adenocarcinoma cells into normal gastric tissues was observed. A total of 28 out of 48 retrieved perigastric lymph nodes were found to be metastatic. A cytologic examination revealed the absence of cancer cells. Immunohistochemical staining revealed that the tumor cells were positive for WT-1, and negative for GCDPF-15 and CD 117 (). The final diagnosis was gastric metastasis from ovarian serous adenocarcinoma. The patient's postoperative course was unremarkable and she was discharged 9 days after the operation. She will undergo another round of chemotherapy with carboplatin plus gemcitabine in consultation with gynecologists.