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.
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.