Traditionally, the gynecologist is the primary physician involved in the assessment of an adnexal mass. History, physical examination, and radiologic evaluation often fail to reveal extrapelvic etiologies for an adnexal mass, especially in the premenopausal woman. Recently three premenopausal women with a pelvic mass referred to the gynecologic oncology service at the University of Kentucky were each found to have gastric carcinoma metastatic to the ovary. This paper discusses the clinical presentation of these women and the indications for the evaluation of the upper gastrointestinal tract in a patient with an adnexal mass.