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.
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.