Cancer Res Treat.  2008 Jun;40(2):93-96.

Primary Epithelial Ovarian Carcinoma with Gastric Metastasis Mimic Gastrointestinal Stromal Tumor

Affiliations
  • 1Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea. seokmo2001@hanmail.net
  • 2Department of Pathology, Chonnam National University Medical School, Gwangju, Korea.
  • 3Department of General Surgery, Chonnam National University Medical School, Gwangju, Korea.

Abstract

Epithelial ovarian carcinoma rarely metastasizes to the parenchyma of the stomach. A 55-years-old woman presented with epigastric pain and a feeling of fullness for one month. A subsequent contrast-enhanced CT scan demonstrated a 4.5 x 4 cm submucosal mass with focal ulceration in the gastric antrum, and this finding was suggestive of GIST. After gastric antrectomy, the final pathology showed metastatic gastric tumor from a primary ovarian serous carcinoma. Because epithelial ovarian carcinoma is usually spread along the peritoneal surface, stomach involvement is rare. Furthermore, transmural gastric metastasis is very rare in a patient with primary ovarian carcinoma. Until now, there has been no reported case of stomach involvement at presentation in a patient with primary ovarian carcinoma. We present here a case of ovarian carcinoma with gastric metastasis that mimicked GIST.

Keyword

Gastric metastasis; Gastrointestinal stromal tumors; Ovarian carcinoma

MeSH Terms

Female
Gastrointestinal Stromal Tumors
Humans
Hydrazines
Neoplasm Metastasis
Pyloric Antrum
Stomach
Ulcer
Hydrazines

Figure

  • Fig. 1 Endoscopic view of the protruding tumor in the stomach with central ulceration.

  • Fig. 2 The left decubitus CT image (A) shows a 4.5×4 cm extrinsic mass (arrows) smoothly compressing the posterior wall of the gastric antrum and abutting to the head of pancreas, which is suggestive of a gastric submucosal tumor such as gastrointestinal stromal tumor (GIST). A focal central ulceration (arrow head) is also noted. The coronal-reformatted CT image (B) demonstrates a 3 cm solid mass (curved arrow) in the pelvic cavity, corresponding to the right ovarian cancer, although it was considered as a metastatic lesion or synchronous small bowel GIST arising in the distal ileum at the time of imaging.

  • Fig. 3 The maximum intensity projection (MIP) reconstruction of the CT-based attenuation-corrected coronal PET image (A) shows multiple hypermetabolic lesions (max SUV, 22.3) in the abdominopelvic region (arrows). The axial fused PET/CT image (B and C) shows intense FDG uptake lesions (max SUV, 22.3) (arrows) in both the gastric antrum and the pelvic cavity abutting to the distal ileum, a finding that can mimic malignant gastric GIST with metastases or with a synchronous small bowel GIST arising from the distal ileum.

  • Fig. 4 Gross photograph of the stomach mass. In (A) the arrow points to the 4.5×4 cm sized submucosal mass of the stomach. (B) is the cut section of the stomach mass. The submucosal mass is shown below the normal mucosa.

  • Fig. 5 The histologic and immunohistochemical findings. Low magnification shows an intramural tumor and the overlying ulcer (A, hematoxylin-eosin, ×40). This tumor is composed of irregular sheets of cells with high-grade nuclear atypia (B, hematoxylin-eosin, ×200). Immunohistochemically, the tumor cells are immunoreactive for Wilms' tumor-1 (C, ×200) and cytokeratin 7 (D, ×200).


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