Synchronous pancreatic and gastric metastasis from an ovarian adenocarcinoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration.

Metastasis of ovarian carcinoma to the stomach [1–5] or pancreas [6,7] is uncommon. Furthermore, synchronous metastasis of ovarian adenocarcinoma to the stomach and pancreas has never been reported. We report here the detection of synchronous metastasis to both the stomach and pancreas from a resected ovarian papillary serous cystadenocarcinoma. At 25 months after gynecological surgery, a gastric submucosal mass and pancreatic masses were noted on follow-up computed tomography in an asymptomatic 51-year-old woman. Contrast-enhanced computed tomography showed a 4.6× 4.2-cm submucosal mass in the gastric antrum (●" Fig.1a) and a 1.0×1.0-cmmass in the pancreatic body (●" Fig.1b). The serum cancer antigen 125 (CA-125) level was high (89U/mL; normal <35U/mL). The patient underwent esophagogastroduodenoscopy (EGD), which showed a 3-cm subepithelial mass at the antrum (●" Fig.2). Endoscopic ultrasound (EUS) demonstrated that the lesion was located mainly in the fourth layer (●" Fig.3). In addition, two pancreatic lesions, measuring 7×5mm and 4×3mm, were identified in the pancreatic body (●" Fig.4). EUS-guided fine-needle aspiration (EUS-FNA) of the gastric and pancreatic lesions was performed, and microscopic examination showed a group of cells with rounded borders and round to oval nuclei in a papillary arrangement (●" Fig.5). Fig.1 Follow-up abdominal contrastenhanced computed tomography in an asymptomatic 51-yearold woman at 25months after gynecological surgery. a A 4.6×4.2-cm intramural mass (yellow arrows) in the gastric antrum is suggestive of a gastric submucosal tumor. b A 1.0×1.0-cm mass (yellow arrows) in the pancreatic body exhibits slight enhancement in the early phase. Fig.2 Gastroscopy shows a 3.0-cm submucosal tumor covered with normal gastric mucosa at the antrum.