Leptomeningeal carcinomatosis and bilateral internal auditory canal metastases from ovarian carcinoma

Abstract

Ovarian cancer, a leading cause of death in women, typically spreads locally and rarely metastasizes to the brain or seeds the leptomeninges. We present a case of a 62-year-old woman with a history of treated ovarian cell carcinoma who developed bilateral sensorineural deafness and right-sided facial weakness and on imaging was found to have bilateral internal auditory canal (IAC) masses and leptomeningeal carcinomatosis, pathologically proven by cerebrospinal fluid cytology. We discuss her magnetic resonance imaging and positron emission tomography-computed tomography findings and review the imaging characteristics of IAC metastases. Finally, we review the literature on leptomeningeal carcinomatosis from ovarian cancer and discuss the high incidence of bilateral IAC metastases in patients with leptomeningeal carcinomatosis.

Iatrogenic Leptomeningeal Carcinomatosis Following Craniotomy for Resection of Metastatic Serous Ovarian Carcinoma: A Systematic Literature Review and Case Report

“…A systematic review of the literature revealed 30 publications that met criteria for cases of leptomeningeal carcinomatosis in ovarian carcinoma, and a total of 32 patients were included ( 5 , 11 , 20 – 47 ). The median time to leptomeningeal carcinomatosis from ovarian carcinoma diagnosis was 24 months, and 41% of patients had brain or spine metastases present before or at the time of leptomeningeal carcinomatosis diagnosis.…”

“…As such, the literature on the natural history and effective treatment strategies of this phenomenon remains sparse. Krupa et al ( 5 ) reported a 62-year-old female with stage IIC high-grade serous ovarian carcinoma with malignant ascites but without involvement of lymph nodes who underwent bilateral salpino-oophorectomy, omentectomy, and adjuvant chemotherapy. She presented approximately one year thereafter with rapidly progressive bilateral sensorineural hearing loss, right-sided facial paralysis, gait instability, and radicular low back pain in conjunction with a marked rise in her CA-125 level ( 5 ).…”

“…Krupa et al ( 5 ) reported a 62-year-old female with stage IIC high-grade serous ovarian carcinoma with malignant ascites but without involvement of lymph nodes who underwent bilateral salpino-oophorectomy, omentectomy, and adjuvant chemotherapy. She presented approximately one year thereafter with rapidly progressive bilateral sensorineural hearing loss, right-sided facial paralysis, gait instability, and radicular low back pain in conjunction with a marked rise in her CA-125 level ( 5 ). Imaging demonstrated bilateral auditory canal metastases with a mass extending to the right cerebellopontine angle as well as several spinal lesions with leptomeningeal involvement ( 5 ).…”

“…She presented approximately one year thereafter with rapidly progressive bilateral sensorineural hearing loss, right-sided facial paralysis, gait instability, and radicular low back pain in conjunction with a marked rise in her CA-125 level ( 5 ). Imaging demonstrated bilateral auditory canal metastases with a mass extending to the right cerebellopontine angle as well as several spinal lesions with leptomeningeal involvement ( 5 ). Behnam et al ( 9 ) described a similar rapidly progressive case in a 55-year-old female who, despite appropriate surgical intervention and adjuvant therapies for stage III serous ovarian carcinoma, developed acute onset paraparesis attributable to diffuse cranial and spinal leptomeningeal disease found on autopsy.…”

“…Ovarian metastases to the brain are a known phenomenon, although they represent less than 2% of cases ( 3 – 8 ). Moreover, leptomeningeal seeding of ovarian carcinoma is an exceedingly rare entity with most cases published as case series or individual case reports ( 5 , 9 – 11 ). As such, the literature on the natural history and effective treatment strategies of this phenomenon remains sparse.…”