Hematemesis Secondary to Isolated Gastric Metastasis from Ovarian Carcinoma

A 49 year old female presented with two episodes of hematemesis. Six years ago she had undergone a total hysterectomy with bilateral salpingo-oophorectomy, omentectomy and pelvic lymph node dissection for a serous papillary carcinoma of the ovary (FIGO stage IIA), followed by adjuvant chemotherapy. On regular follow up she remained disease free, until presentation. Her hemoglobin was 9.1g/dl and CA-125 level was elevated-128u/ml. Gastroscopy revealed an ulcerated submucosal tumor in the antrum measuring 5x4cms with no e/o active bleeding & minimal altered blood in stomach. Biopsy showed scanty metastatic tumor deposits from ovarian cancer. CT scan of chest, abdomen & pelvis showed a large, well-defined heterogeneously enhancing serosal mass lesion in the antrum of the stomach with soft calcification within, with no ascites. Few paraortic lymph nodes were enlarged. No other organ involvement was observed. She received chemotherapy and is currently on close follow up. Isolated gastric metastasis from an ovarian cancer is extremely rare and most often occur in advanced stage with synchronous lesions in the peritoneum. Histologically serous carcinoma is the most common variety. Clinicians should consider that in patients with submucosal tumor and history of ovarian carcinoma, the gastric lesion may be metastatic and not a primary gastric carcinoma.