Ovarian cancer can present with elevated CA-125 and peritoneal metastases; however, histological and immunohistochemical findings are inconsistent with ovarian cancer which would involve tumor cells in the dermis with nodular contours forming rudimentary ducts and intracytoplasmic inclusions and paired box 8, Wilms tumor-1, and estrogen receptor positivity. The gene discussed is ESR1; the disease is ovarian carcinoma.