Brain Metastasis of Ovarian Epithelial Carcinoma

Ovarian cancer is the seventh most common cancer and the fifth leading cause of cancer death in the world, after lung and bronchial cancers, and breast, colorectal and pancreatic cancers. Ovarian cancer causes more deaths than any other cancer of the female reproductive system. Brain metastases resulting from primary ovarian cancer are uncommon [1]. However, recent studies have suggested an increased incidence of brain metastases in patients with primary ovarian cancer [2–4]. Surgery, irradiation, and chemotherapy can all be used to prolong patient survival, although the prognosis remains poor [4]. McMeekin et al [5] studied the survival of 104 ovarian cancer patients with metastatic brain disease following a combination of surgery, irradiation, and/or chemotherapy. Their report indicated a median survival of 6 months for these patients, regardless of the treatment modality [5]. Some investigators have reported relatively successful efforts in prolonging the life of these metastatic patients. Gabriele et al reported a mean survival of 17 months in a group of 23 ovarian cancer patients with solitary brain metastases treated with surgery and radiotherapy [6]. The survival of ovarian cancer patients with metastatic disease treated with irradiation was around 2 years [5,7]. Systemic chemotherapy has also proven effective for the treatment of brain metastases [1,7]. A 58-year-old Taiwanese woman was originally referred to our gynecologic oncology clinic for treatment of an ovarian epithelial carcinoma in May 2005. She presented with increased abdominal girth and poor appetite. Her preoperative serum CA-125 level was 4,491 U/mL. She underwent laparotomy with optimal debulking surgery (en bloc total abdominal hysterectomy and bilateral salpingo-oophorectomy, and cavitron ultrasonic surgical aspirator debulking from the peritoneal surfaces). The pathology revealed a poorly differentiated stage IIIC ovarian serous adenocarcinoma (Figure 1) with metastasis to the omentum, appendix, paraortic and pelvic lymph nodes. The patient subsequently received six courses of paclitaxel and carboplatin, commencing in June 2005. Her CA-125 level fell to 12.7 U/mL in November 2005, and complete clinical and surgical remission was achieved. Another 12 courses of maintenance paclitaxel chemotherapy were administered thereafter, and her serum CA-125 level ranged from 12 to 15 U/mL until November 2006. In May 2007, she presented with intermittent headaches, nausea, cognitive dysfunction, gait ataxia, and urinary and fecal incontinence, resulting in consultation with a neurologist. There was no weakness, syncope or seizure history. A brain magnetic resonance imaging examination revealed a 5-cm mass in the left frontal lobe with a cystic component and irregular thick wall, and perifocal edema with compression of the left lateral ventricle, resulting in midline structures shifting to the right side (Figure 2). No other apparent lesions were noted in the abdomen, chest or spine. An elevated serum CA-125 level, as high BRAIN METASTASIS OF OVARIAN EPITHELIAL CARCINOMA