S6124 Duodenal Ulcer Pathology: An Embryological Exploration

Introduction: Müllerian duct adenocarcinoma, arising from tissues of the woman genital tract, is a rare malignancy with an unusual pattern of metastasis to the gastrointestinal (GI) tract. While peritoneal seeding is the most common mode of spread, GI involvement is exceedingly rare. We present the case of a 70-year-old woman with a history of stage IV serous ovarian adenocarcinoma in remission following surgical and medical therapy. After being lost to follow-up for several years, she presented with symptoms suggestive of an upper GI bleed and was ultimately found to have metastatic Müllerian disease involving the duodenum. Case Description/Methods: A 70-year-old woman with stage IV serous ovarian carcinoma, previously treated with chemotherapy, BSO, peritoneal stripping, omentectomy, and resection of multiple abdominal masses in 2017, presented with several months of epigastric pain, weight loss, food aversion, and melena. She had been lost to follow-up since 2022, after discontinuing rucaparib. She denied nonsteroidal anti-inflammatory drug, tobacco, or alcohol use and had no history of endoscopic evaluations. In the emergency department, she was afebrile and hemodynamically stable. Labs revealed hemoglobin of 7.4 g/dL (baseline ∼12) and MCV 73 fL. Exam showed conjunctival pallor and melena on rectal exam. She received intravenous pantoprazole and symptomatically improved, though her hemoglobin later dropped to 6.8 g/dL, requiring transfusion. Computed tomography imaging showed nodular thickening of the gastric antrum, pylorus, and duodenal bulb. Esophagogastroduodenoscopy revealed LA Grade C esophagitis and an externally compressing duodenal mass, impeding scope passage. Endoscopic ultraouns confirmed a >5.5 cm hypoechoic, ulcerated mass in the proximal duodenal bulb with recent bleeding. Biopsies were consistent with recurrent Müllerian duct adenocarcinoma. Discussion: This case highlights a rare presentation of Müllerian duct adenocarcinoma metastasizing to the gastrointestinal (GI) tract years after initial remission. Despite aggressive surgical debulking and peritoneal stripping, the patient developed late recurrence in the duodenum—an uncommon site for ovarian cancer spread. It emphasizes the importance of long-term surveillance and considering metastatic disease in patients with a remote cancer history presenting with new GI symptoms.