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 April, 2012, a 51-year-old female presented to the Department of Gynecology of the First Affiliated Hospital of Nanjing Medical University (Nanjing, China) complaining of lower abdominal pain of two months in duration. A computed tomography (CT) scan of the abdomen and pelvis showed bilateral adnexal complex masses. The patient subsequently underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy with pelvic lymph node dissection and omentectomy for stage III ovarian adenocarcinoma (International Federation of Gynecology and Obstetrics). The surgery was followed by four cycles of adjuvant chemotherapy with paclitaxel and cisplatin. The patient was in good condition and achieved complete clinical response in June, 2012. In December, 2013, the patient was admitted to the Department of Oncology, First Affiliated Hospital of Nanjing Medical University due to significantly elevated serum CA-125 levels (up to 96.05 U/ml; normal, <35 U/ml), which is an important tumor marker. Other tumor markers were within the normal range. The patient had no abdominal discomfort, hematemesis, melena, weight loss or any other clinical manifestations. Scanning with 18F-fluorodeoxyglucose positron emission tomography(18F-FDG PET)/CT ruled out recurrent ovarian carcinoma, which was suspected due to the high CA-125 levels. The 18F-FDG PET/CT images revealed a high-uptake lesion in the antrum of the stomach () and a high-uptake lymph node behind the pancreas (). During the subsequent endoscopic examination, a 1.5×2.0-cm submucosal mass covered with normal gastric mucosa was identified in the gastric antrum (). Due to the location of the lesion, the patient was referred for endoscopic ultrasound examination, which revealed a hypoechoic mass emanating from the muscularis propria, with the typical appearance of a gastrointestinal stromal tumor (). The patient subsequently underwent surgical resection of the gastric lesion and the intumescent lymph nodes. The intraoperative findings included a 2.5×2×2-cm isolated extrinsic mass on the wall of the gastric antrum and a 1.0×0.8-cm intumescent lymph node close to the lesser curvature of the stomach. The histopathological examination confirmed ovarian cancer relapse involving the gastric wall without mucosal involvement, although a lymph node was involved. Immunostaining for progesterone receptor, estrogen receptor, cytokeratin 7 (CK7) and Wilms’ tumor-1 (WT1) was positive; while immunostaining for CK20 was negative (). These findings were consistent with the primary ovarian cancer (). The patient was discharged on the 10th day after surgery. At the time of writing, the patient had received another two cycles of adjuvant chemotherapy, and the CA-125 level had decreased to the normal range.