In October 2015, a 45-year-old female was admitted to our hospital with a 1-year history of pelvic mass. Computed tomography (CT) examination showed bilateral ovarian tumors. Her serum cancer antigen 125 (CA125) level was 11.22 kU/L (reference range: 35.0 kU/L). Serum carcinoembryonic antigen (CEA) level was 1.31 µg/mL (reference range: 0–6.5 µg/mL). She underwent a total hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymph node dissection with total omentectomy subsequently. Postoperative pathological examination showed bilateral ovarian serous cystadenocarcinoma. Immunohistochemical examination yielded the following results: CK (+++) (), Ki-67 (+++) (), P53 (+++) (), S-100 (−), and villin (−) (). The International Federation of Gynecology and Obstetrics (FIGO) stage was IIA. After cytoreductive surgery, the patient followed eight cycles of adjuvant chemotherapy with paclitaxel 175 mg/m2 over 3 hours plus carboplatin area under the curve (AUC) =5, every 21 days as one cycle. After the chemotherapy, the patient was followed up by means of reexamination every 3 months. Therapeutic evaluation was stable.\nIn November 2017, the patient was presented to our hospital again with abdominal pain. Subsequent abdominal enhanced CT examination showed the lesion occupying the lesser curvature of the gastric antrum, which was of size 3.6×2.8 cm (). Gastroscopy showed chronic superficial gastritis and submucous eminent lesions in the lesser curvature of the gastric antrum (size 3.5×2.5 cm; ). Combined with the results of CT and gastroscopy, we diagnosed the patient with gastrointestinal stromal tumor (GIST). Then, we performed a fine needle aspiration (FNA) biopsy under endoscopic ultrasonography. The gastric metastasis was located in the intrinsic myometrium. H–E staining revealed the gastric metastasis of ovarian serous cystadenocarcinoma (). The serum CA125 level was 10.40 kU/L. The patient underwent pelvic enhanced CT examination and brain magnetic resonance imaging (MRI) examination, and no other metastases were found. Subsequently, laparoscopic resection of the gastric metastasis was accepted. Because the interval between the last chemotherapy was ~18 months, ie, the platinum-free interval (PFI) was >12 months, the patient underwent another eight cycles of adjuvant chemotherapy with carboplatin plus gemcitabine. The patient was reexamined after every two cycles of chemotherapy. The serum CA125 levels showed no elevation. She is currently in complete remission. Written informed consent has been provided by the patient to have the case details and any accompanying images published.
The patient is a 55-year-old female with known stage III b serous ovarian cancer. She had undergone an abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy, followed by 6 cycles of carbo/taxol chemotherapy with complete clinical response. She was free of disease for 2 years until her disease recurred and was treated with Carboplatin and Taxol. The carboplatin was eventually switched to Doxil. However, the repeat positron emission tomography (PET) scan at that time showed progression of her disease. Thus she underwent exploratory laparotomy with removal of a splenic mass. She was noted to have peritoneal carcinomatosis at that time and was then treated with Gemzar. The patient had stable disease after this treatment. Five years after the initial diagnosis, the patient was admitted to the hospital with anemia, hemoglobin of 7.0 gm/dl, fatigue, and melena. Computerized Tomography (CT) of the abdomen without IV contrast was obtained on admission, which revealed calcified, heterogeneous, mixed intermediate and high-density deposits worrisome for peritoneal carcinomatosis (, arrows). No IV contrast was administered due to her poor kidney function. She was referred for an EGD, which showed a 7 mm erythematous lesion at the gastroesophageal junction and a 1.5 to 2 cm subepithelial mass () with a superficial overlying erosion in the antrum, but no obvious source for any active bleeding. Initial endoscopic biopsies of the gastroesophageal junction lesion showed granulation tissue polyp with foveolar hyperplasia, and the antral biopsies were normal. Due to the presence of a subepithelial lesion in the antrum, the patient was referred for EUS. Two subepithelial lesions were discovered by EUS, one in the antrum measuring 3.4 × 3.7 cm () and one in the body of the stomach 1.2 × 0.8 cm (). The lesion in the body of the stomach was not appreciated during the EGD. The lesions were hypoechoic masses emanating from the muscularis propria and had the typical appearance of gastrointestinal stromal tumors. FNA was performed of both masses. Both sites revealed papillary adenocarcinoma from an ovarian papillary serous adenocarcinoma primary (). Immunostains for progesterone receptor, estrogen receptor and p 53 were focally positive and confirmatory. The patient was treated with Taxol and is undergoing surveillance imaging.