Cerebrospinal fluid‐dissemination of a ovarian clear cell carcinoma: A leptomeningial carcinomatosis with diagnostic challenges

Abstract

Metastases from ovarian cancer to the central nervous system (CNS) are rare, in particular, isolated leptomeningeal metastases (LM) are extremely rare. The gold standard in the diagnosis of leptomeningeal carcinomatosis (LC) is the detection of malignant cells in cerebrospinal fluid (CSF) cytology. A 58‐year‐old woman diagnosed with ovarian cancer 2 years ago underwent lumbar puncture and CSF cytology in recent months due to new weakness, loss of strength in the lower extremities, and speech disorders. Magnetic resonance imaging CNS was simultaneously visualized and linear leptomeningeal enhancement was demonstrated. CSF cytology showed tumor cells as isolated cells or small clusters of tumor cells with large, partially vacuolated, and abundant cytoplasm, mostly with centrally located nuclei. Given her history of high‐grade clear cell ovarian cancer,CSF cytology was positive for malignant cells and a diagnosis of leptomeningeal carcinomatosis was made by the neuro‐oncology multidisciplinary tumor board. Since LM also implies a systemic disease, the prognosis is very poor, CSF cytology will play an important role in rapid diagnosis and will be useful both in the right choice of treatment and in the early initiation of palliative care.

Leptomeningeal Carcinomatosis From Primary Mucinous Carcinoma of the Ovary

“…The diagnosis of LMC can be challenging due to the low sensitivity of various diagnostic modalities. The gold standard for diagnosis of leptomeningeal disease is documentation of malignant cells in CSF cytological examination [5]. However, after discussing the highly characteristic MRI findings and the likelihood that CSF cytology would not alter her management, the patient declined a lumbar puncture.…”