Radhika Kulkarni
Despite advances in medical diagnostics and treatment, ovarian
carcinoma continues to be a disease detected at a late stage when
metastasis has occurred. Ovarian cancer spreads early to the
peritoneum resulting in massive and rapidly accumulating ascites.
Central nervous system metastasis, though rare has been reported.
Here, we report a case of papillary serous carcinoma of the ovary
in a sixty-year-old female who had florid metastasis involving the
brain and the spinal nerve roots. Her cancer was detected when
intra-abdominal spread had occurred; however, she did achieve a
period of clinical remission with chemotherapy and PARP inhibitors.
Her treatment included neo-adjuvant chemotherapy with carboplatin
and paclitaxel, debulking of the tumor, and adjuvant chemotherapy
with carboplatin and docetaxel. When her disease relapsed, she was
started on a PARP inhibitor Niraparib which kept her in remission
for another year. Her genetic testing was positive for the BRCA 1
mutation. She developed metastases to the brain and spinal cord
with involvement of the spinal nerve roots. She ultimately developed
carcinomatous meningitis and succumbed to the disease. It was
of interest to speculate the reason for this pattern and degree of
spread of her cancer. Do genetic mutations have a role to play? Data
is sparse on the role of BRCA mutations as being a contributor to
early or aggressive spread in ovarian cancer.