EPITHELIAL OVARIAN CANCER WITH CENTRAL NERVOUS SYSTEM METASTASIS - CASE REPORT

Epithelial ovarian cancer rarely metastasizes to central nervous system (CNS). We present a case of ovarian cancer with CNS metastasis. The patient presented with ascites, left ovarian mass and increased serum level of CA-125. The diagnosis was ovarian cancer and the patient underwent to debulking surgery. Pathologic diagnosis was serous carcinoma moderately differentiated containing clear cell components and arising from left ovary. The stage was 3 C mixed ovarian epithelial carcinoma and the patient received 9 courses of adjuvant chemotherapy (Paclitaxel 300 mg + Carboplatin 750 mg). Second look laparotomy was subsequently performed which showed no tumoral lesion. 10 months later, the patient presented with the complaint of severe headache. Magnetic resonance imaging (MRI) of the brain revealed 3 metastases. Palliative radiotherapy and oral dexamethasone were started but the patient was lost to follow up within two months. The frequency of CNS metastases of epithelial ovarian cancer range between 1-6% in autopsy series and 0.5-12% in clinical series. The metastases may be isolated or multiple. The existence of multiple brain metastases is a poor prognostic factor. The treatment options are chemotherapy, radiation therapy and surgery. The appropriate treatment should be chosen on an individual basis. Corticosteroids, antiepileptics and mannitol can be used in palliative care for the patients with poor survival.