Family and clinical history of a Mendelian diffuse gastric cancer. The pedigree of the index patient 525 (III-1) is depicted. Tumor types are indicated by color including green for pancreatic cancer, red for diffuse gastric cancer, and yellow for breast cancer. The patient presented with her primary gastric cancer at the age of 37 years. Three years later she presented with an abdominal discomfort. Contrast-enhanced CT scan of the pelvis identified a left ovary mass (yellow circle) that was confirmed on biopsy to be a diffuse gastric cancer metastasis (that is, Krukenberg tumor). During the course of metastatic tumor evolution, a number of known and candidate cancer driver events delineated the tumor evolution and genetic divergence of the metastasis from the primary tumor.