BRCA2-positive spinal intramedullary ovarian metastatic disease: case report.
Spine J. 2015 Nov 6;
Authors: Ravindra VM, Mazur MD, Driscoll M, McEvoy S, Schmidt MH
BACKGROUND CONTEXT: Ovarian cancer is the fourth leading cause of cancer death in women, but advances in treatment have led to longer survival among these patients. Tied to these advances and increased survival, however, have been new patterns of metastatic spread.
PURPOSE: The authors discuss the management and surgical decision-making in patients with intramedullary ovarian metastatic disease using a case illustration and relevant literature.
STUDY DESIGN/SETTING: Case report.
METHODS: The authors describe a case of a 59-year-old woman with BRCA-2-positive ovarian cancer who developed progressive myelopathy from a T10-T11 intramedullary metastatic lesion.
RESULTS: The patient underwent a standard open T10-11 laminectomy for intramedullary tumor resection. Intraoperative ultrasound was used to direct the dural opening over the lesion. After a posterior midline myelotomy, microsurgical dissection revealed the intramedullary tumor with a discolored fibrous capsule, which was carefully dissected off of the spinal tracts, and a gross total resection was achieved. Postoperative MRI at 6 months demonstrated no evidence of residual or recurrent intramedullary tumor. The patient underwent adjuvant external beam radiation to the thoracic spine but succumbed to her primary disease one year after surgery.
CONCLUSIONS: Although central nervous system involvement of ovarian cancer confers a poor prognosis, patients presenting with a solitary lesion and neurological deficit may benefit from surgical resection followed by steroids and radiation therapy, especially when tissue diagnosis is necessary.
PMID: 26552643 [PubMed – as supplied by publisher]