Metastatic brain disease in early stage ovarian cancer: A ca
Ovarian cancer rarely metastasizes to the brain. If it does, it is more likely to occur with advanced stage carcinomas, more than one year after diagnosis, and rarely presents as a single lesion. Early detection, treatment, and close follow-up is essential to optimize prognosis and prevent long-term disability.

Here presents case of a 54-year-old woman with significant past medical history of endometrioid ovarian cancer (stage Ia, grade 3) presented to the emergency department with a primary complaint of left-sided headache. She had been experiencing retro-orbital headaches for the last several months without other neurological deficits. A head CT was performed. This demonstrated a left frontal 2.4 × 2.4 cm lobe mass with surrounding edema. An MRI was subsequently performed which demonstrated a heterogeneously enhancing circumscribed 2.5 cm mass within the left anterior frontal region with extensive vasogenic edema, mass-effect and midline shift.

Due to a recent history of endometrioid ovarian cancer (stage Ia, grade 3). After surgical intervention , the patient underwent 6 cycles of Paclitaxel (Taxol) and Carboplatin (Carbo). She was started on intravenous steroid therapy along with antiseizure medications. A serum CA-125 was 7 unit/mL, which was unchanged from baseline and both 6 and 12 months before. The patient underwent a left stereotactic frontal craniotomy with resection of an intradural, intra-axial mass 4 days after admission. The patient tolerated the procedure well and was transferred to the neurology ICU for postoperative management.

On postoperative day 5, increased hemorrhage was noted and IV anticoagulation was halted. A transesophageal echocardiogram was obtained and demonstrated a large 4.6 × 2.1 cm echogenic broad-based mass adherent to the right atrial wall. This was most consistent with a thrombus however malignancy was still unable to be ruled out.

The final pathology of the left frontal mass was significant for metastatic poorly differentiated adenocarcinoma. This lesion was similar to some of the poorly differentiated foci of the ovarian carcinoma. The patient remained stable and was discharged 14 days after the initial presentation. Further management included brain radiation therapy with four cycles of Carbo/Taxol adjuvant chemotherapy.

In conclusion, the risk of metastatic brain lesions from ovarian cancer is positively correlated with advanced stage disease. Time to metastasis has no such association and typically occurs more than one year after diagnosis. Other proposed associations include genetic mutations and chemotherapeutic drugs.

1 share