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.
The patient was a 61-year-old woman diagnosed in November 2013 with stage IV high-grade serous carcinoma of the ovary treated with cycles of carboplatin and taxol chemotherapy with partial clinical response. After 1-year of therapy, due to the persistence of abdominal and pelvic disease, cytoreductive surgery had been performed. In June 2015, her CA125 levels had increased to 138 U/mL (normal value < 35 U/mL) and a computed tomography (CT) of the abdomen showed progression of the disease.\nShe was referred at that time to our endoscopic center for evaluation of dyspepsia. Upper GI endoscopy revealed an SET covered by normal mucosa on the posterior wall of the gastric antrum (Figure ). Biopsies of the overlying mucosa proved inconclusive. EUS showed a 23-mm mass within the muscularis propria, hypoechoic but more hyperechoic than the muscular tissue (Figure ). EUS-guided fine needle biopsy (FNB) was performed for tissue diagnosis. Histology showed adenocarcinoma with immunohistochemistry positive for WT1 and CK7, and negative for CK20 and CDX2 (Figure ). These findings supported the final diagnosis of a metastatic adenocarcinoma of ovarian origin. The patient started paclitaxel chemotherapy and was alive at the 18-mo follow-up visit.