Brain metastasis is a rare and late manifestation of ovarian carcinoma. A 30-year-old woman initially presenting with neurologic symptoms was later found to have mucinous ovarian carcinoma. The patient had a 6 cm adnexal mass with multiple millimetric brain metastatic lesions. Following a surgical staging laparotomy procedure, the patient received brain irradiation and systemic chemotherapy.
Brain metastasis from ovarian carcinoma is very uncommon; only less than 600 cases have been documented to date in the literature and it might be seen as a late manifestation of an ovarian tumor [
A 30-year-old gravida 2, para 2 woman admitted to our hospital with complaints of headache, nausea, vomiting, and right-sided blurred vision. She did not report any previous medical history or malignancy. Her neurologic examination revealed a right optic disc edema suggesting a posterior orbital mass. Her cranial computerized tomography (CT) scan showed multiple lesions that are a 6 mm mass on the right parietal lobe, a 16 mm mass on the left occipital, and another 7 mm mass on the left temporal lobe (Figures
Cranial CT scan: lesion on the right parietal lobe.
Cranial CT: left occipital cortical lesion.
For identification of the primary malignancy, she initially underwent thoracic and abdominopelvic CT. Upper abdominal CT scan revealed indistinctly bordered and heterogeneously contrast accumulating multiple lesions less than 15 mm in the liver. There was a pelvic tumor of
Pelvic MRI: the right adnexal mass.
The patient underwent a diagnostic laparoscopy for further evaluation of the adnexal mass. Biopsy of the adnexal mass and the liver was obtained and the pathologic examination revealed an ovarian mucinous cystadenocarcinoma with metastatic lesions of liver. The patient then was subjected to a laparotomy for a surgical staging procedure including total abdominal hysterectomy, bilateral salpingooophorectomy, bilateral pelvic and para-aortic lymphadenectomy, and infracolic omentectomy and appendectomy. Her postoperative course was uneventful and she was discharged at the 6th postoperative day. The patient was determined to have a stage IV ovarian carcinoma with brain metastasis. An adjuvant therapy including whole brain irradiation (a total dose of 30 Gy in 10 fractions and 3 Gy per fraction) with simultaneous dexamethasone and systemic chemotherapy (two lines of six cure 400 mg/m2 carboplatin plus 175 mg/m2 paclitaxel with three weeks interval) was administered postoperatively. While documenting the patient, she was still alive 1.5 years after the initial diagnosis.
Ovarian cancer still remains as one of the leading causes of cancer related deaths in women. The majority of women with ovarian carcinoma have nonspecific pelvic and abdominal symptoms. Ovarian carcinoma is often diagnosed at an advanced stage but the disease rarely extends outside the peritoneal cavity. Central nervous system involvement in ovarian carcinoma is a very rare and late complication with an incidence of approximately 1% [
Metastasis is an important issue for tumor treatment and has great effects on survival rates. 5–30% of ovarian cancers are metastatic malignancies and colorectal adenocarcinoma is one of the outstanding causes of that situation. Colonic adenocarcinoma has similar features with primary ovarian carcinoma and can mimic it so colonic adenocarcinoma is the foremost misdiagnosed entity [
The differential diagnosis of brain metastases includes primary intracranial tumor, brain abscess, cerebral infarction, and cerebral hemorrhage [
The germline mutations BRCA1/2 cause women to have a tendency for cancer. With another point of view, up to 10% of ovarian cancer patients carry BRCA1/2 mutations [
The most common presenting symptoms of brain metastasis is headache, nausea, and vomiting which are related to increased intracranial pressure [
Chen et al. found that the majority of the patients were under 65 years old and the age of patient at the time of diagnosis was not related to the survival period while the median survival rate for patients >65 and <65 is 41.9 and 8.9 months, respectively. The most common symptom and sign were headache and motor disfunction, respectively. Single lesion and surgical management of the lesion with combination therapy were favourable for these groups with better outcomes of prognosis [
Despite improvements in surgery and chemotherapy for ovarian carcinoma, survival is still limited. In most of the cases with cerebral metastasis, the prognosis is even poorer. Once the brain metastasis develops, the prognosis is very poor; the main therapeutic aim is to palliate and help the patient for a moderate status, and the median survival time is 3–6 months; 15% of patients are alive at the end of a year [
Surgery, whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRC), gamma knife surgery (GKS), chemotherapy, and alternative combination of these methods could be applied for metastatic brain lesions which were described in the literature before.
Anupol et al. used gamma knife surgery (GKS) for a patient and had a good outcome; GKS treats multiple lesions at the same time, is easy to perform for recurrent and new lesions, and has a short hospital stay with less risk of deficit [
Our patient was 30 years old with simultaneously diagnosed multiple metastatic brain lesions of ovarian cancer, so a surgical approach to brain lesions would not be approved. She was treated with surgical staging with the removal of the primary tumor in the abdomen, systemic chemotherapy (taxol and carboplatin) with brain radiation therapy. However, the cause of death in the majority of the patients was related to both brain metastasis and abdominal spread of disease [
And although brain metastasis is uncommon in ovarian carcinoma, it may develop even in the early phase of the disease.
Authors did not receive any financial support for the preparation of this paper. Authors did not have communications with any company during the preparation of this paper.