2703 Gastric Metastasis From a Primary Ovarian Cancer

Abstract

INTRODUCTION: Metastasis to stomach is very rare in general and often related to a breast or a lung primary. Ovarian cancer metastasizing to the stomach is extremely rare. We are reporting a very unusual case of a lady who had gastric metastasis from the primary ovarian cancer more than 3 years after the initial diagnosis. Serosal tumors are more likely to metastasize in comparison to the mucinous type. CASE DESCRIPTION/METHODS: A 49 year old Hispanic lady who had originally presented 3.5 years prior to her recent admission with abdominal pain and bloating. Work-up confirmed bilateral ovarian masses. Staging was negative for liver, lung and brain involvement. She had surgery. The pathology confirmed papillary serous adenocarcinoma with appendiceal and omental involvement. Estrogen and progesterone receptors were positive. She was considered to have Stage III-C disease, and started with chemotherapy. Unfortunately, within a few months, she came in with shortness of breath with imaging showing bilateral pleural effusions. She had thoracentesis which confirmed metastasis from her primary ovarian cancer. Her staging status was changed to IV. She was started on palliative chemotherapy. She would respond partially at first, but then she did show progression of the cancer. She then presented to the hospital recently with GI bleeding, anemia, sepsis, acute renal failure, leukocytosis and respiratory compromise. An upper endoscopy showed a large cratered malignant appearing ulcer in the body of the stomach. Biopsies confirmed adenocarcinoma from the ovarian source. Based on her advanced disease, and multi-system organ failure, the family decided on hospice care. DISCUSSION: Ovarian cancer metastasizing to the stomach is exceedingly rare. The symptoms are usually vague as the involvement is often serosal or sub-mucosal from local infiltration from the peritoneal carcinomatosis. However, hematogenous spread can occur as well. Presentation is often late, months to years after the initial diagnosis of the cancer. EGD should be considered in ovarian cancer patients presenting with upper GI symptoms. EUS/FNA biopsy may help in the diagnosis of the submucosal lesions. Prognosis is usually poor with average life expectancy after the diagnosis of gastric metastasis being 15 months.