Ovarian Carcinoma Initially-presented as Cerebral Metastasis: Epidemiology, Pathology, and Outcomes

An initial presentation of ovarian carcinoma with brain metastasis has been reported in the literature in a limited number of cases, as ovarian cancer rarely metastasizes to the brain.

This study aims to a) Systematically review the literature to identify studies on ovarian carcinoma presenting initially as cerebral metastasis and b) to investigate cases of ovarian carcinoma that were initially presented with cerebral metastasis.

A PRISMA-guided systematic review was conducted, coupled with a retrospective study at the King Abdullah University Hospital from 2005 to 2020. Two hundred sixty-three ovarian carcinoma cases were analyzed for the presence of brain metastasis, out of which 25 were positive for brain metastasis, and seven of them presented initially with neurological symptoms. Demographics, clinical features, histopathology, and treatments were identified.

Eight out of 215 studies conducted between 1999 and 2024 satisfied the criteria for ovarian cancer initially manifesting with neurological symptoms. In the retrospective analysis, 85% and 71% of patients, with a mean age of 41, exhibited headache and impaired vision. Serous cancer manifested in 58%, with solitary brain lesions observed in 71%; surgical intervention yielded improved outcomes. Multimodal treatments involving craniotomy, radiation, and chemotherapy resulted in a median survival of 18.7 months. Fertility drugs utilization was recorded in 57%, indicating a possible association with aggressive illness.

This study illustrates that ovarian cancer presenting as brain metastases at its initial presentation is rare and should be considered in younger women with fertility drugs usage. Long-term risks of fertility drugs should be assessed as use increases. Multimodal therapy improves survival and results.