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 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.