What happened, in summary

A 65-year-old woman had been diagnosed 2 years earlier with poorly differentiated adenocarcinoma of the gastric antrum. She received 3 cycles of FOLFOX with stable disease. Later, cancer spread to both adnexal areas as Krukenberg tumors. She then received 6 cycles of nivolumab plus XELOX, which produced tumor shrinkage with stable disease, followed by maintenance nivolumab and capecitabine. She later arrived in the emergency department with abdominal pain, syncope, low blood pressure, and internal bleeding. Emergency surgery found hemorrhagic infarction of a Krukenberg tumor caused by torsion of its pedicle. Her course was complicated by profound hypotension around anesthesia, with severe hypothyroidism considered an immune-related effect of nivolumab. She recovered after surgery and thyroid treatment. Six months later she was doing well clinically and attending regular oncology follow-up while living with metastatic gastric cancer.