Unusual Early Cerebral Metastasis of Ovarian Carcinoma as Initial Presentation

Background: Although systemic malignancies are frequently metastasizing to the central nervous system (CNS), ovarian carcinoma, which is a common malignancy in females, is rarely affecting brain. In general, the outcome for ovarian carcinoma with brain metastases is dismal as most of these patients usually present late with metastases elsewhere.Materials and methods: A retrospective review of four cases with cerebral metastases as the initial presentation of ovarian carcinoma in patients ages 25 to 45 years. Three patients received hormonal therapy for infertility. All cases presented initially with symptoms and signs suggestive of increased intracranial pressure with unknown primary pathology. CT and MRI scans showed intracranial enhancing lesions in different locations. Full malignancy work up showed a primary lesion arising from the pelvis with no other lesions detected.Results: Three patients underwent laparotomy for ovarian carcinoma resection once their neurological condition optimized, one case died early before she had laparotomy. All cases underwent Craniotomy for excision of the solitary metastatic lesion. In all cases, the histopathology demonstrated metastatic ovarian carcinoma. Subsequently, patients received chemo-radiotherpy. Although treatment all cases died within two years.Conclusion: It is unusual for ovarian carcinoma to present initially with CNS involvement. Unlike other primary tumours, ovarian carcinoma does not have a predilection for the central nervous system. However, CNS involvement occurs at late stage of the disease. Although multimodal treatment the outcome still poor. Hormonal therapy for infertility may be a risk factor for ovarian carcinoma and its aggressive behavior with cerebral metastasis.