Slow progression of calcified cerebellar metastasis from ovarian cancer: a case report and review of the literature

Abstract

The report describes a rare case of a patient with a calcified cerebellar metastasis arising from a primary ovarian cancer. The patient was a 33-year-old woman with a long history of stage IIIc ovarian cancer who had undergone transabdominal hysterectomy and bilateral oophorectomy followed by chemotherapy with gemcitabine hydrochloride. Incidentally, computed tomography (CT) revealed a cerebellar tumor with calcification. The size of the tumor gradually increased, and lateral suboccipital craniotomy was performed for gross total removal of the tumor. The histological diagnosis was ovarian mucinous adenocarcinoma. The patient's postoperative course was uneventful, and she was discharged two days after surgery. Brain metastases from ovarian cancer are rare. In the review of metastatic brain tumors arising from a primary ovarian cancer in the Department of Obstetrics and Gynecology at our institution, this phenomenon was noted in only 10 cases (0.24%) of 4,158 patients with ovarian cancer seen at our center over a period of 8 years. Moreover, only three cases of calcified metastatic brain tumor have been reported previously. In conclusion, complete tumor resection may be an acceptable approach for patients with calcified metastatic tumors both for therapeutic considerations and to obtain tissue for confirmation of histopathological diagnosis. Metastatic brain tumors can be calcified, and should be considered within the differential diagnosis of calcified intracranial lesions to avoid any delay in diagnosis or treatment.

Fig. 1

Preoperative computed tomography (CT) scan showing calcified tumor in the right cerebellar hemisphere. A: A calcified tumor in the right cerebellar hemisphere was incidentally discovered 2 years before surgery. B: Follow-up CT 1 year later revealed slow growth of the tumor. C: The tumor grew progressively, compressing the brainstem. The ambient and quadrigeminal cisterns were not visualized, and the inferior horn of the lateral ventricle was enlarged.

Fig. 2

Preoperative magnetic resonance imaging (MRI) showing a lesion in the right cerebellar hemisphere that was isoin-tense on T₁-weighted imaging (A) and that was hyperintense on T₂-weighted imaging (B). The tumor was heterogeneously enhanced with gadolinium on axial (C) and sagittal images (D). Note the tonsillar herniation causing, compression of the brainstem and obstructive hydrocephalus.

Fig. 3

Photomicrograph revealing mucinous tumor cells with acinar formation and papillary proliferation. Tumor contained psammomatous bodies in the stroma with atypical and mitotic cells (hematoxylin and eosin: A, ×40; B, ×200).

Fig. 4

Postoperative computed tomography (CT) scan showing that the calcified tumor was totally removed.

Fig. 5

Postoperative T₁-weighted (A) and T₂-weighted (B) magnetic resonance (MR) imaging, and MR image with gadolinium in the axial (C) and sagittal (D) planes, showing that the tumor was completely removed. Note that the brainstem was decompressed and that hydrocephalus had improved.