Cranial and intra-axial metastasis originating from a primary ovarian Dysgerminoma

Abstract

Dysgerminomas are aggressive germ cell tumors that typically have a favorable prognosis, especially in patients diagnosed with early stage disease. We recount the history of a 23-year-old woman who was treated for a stage IA ovarian dysgerminoma in November 2017. Postoperatively, the patient was noncompliant insofar as obtaining routine lab evaluations; ten months later, she was diagnosed with a cranial metastasis that extended into the meninges. The patient subsequently underwent a craniotomy and adjuvant etoposide, bleomycin and cisplatin chemotherapy to which she initially responded; however, during cycle 4, she developed pancytopenia whereupon the chemotherapy was summarily discontinued. Thereafter, the patient was surveilled and currently, she remains in clinical remission. Early stage ovarian dysgerminoma, albeit rarely, has the capacity to metastasize to the cranium or brain, further underscoring the significance of employing active follow-up with these patients.

Uncommon Metastasis of Ovarian Dysgerminoma: A Case Report and Review of the Literature

“…The most common metastases of dysgerminoma are the peritoneal cavity, omentum (86%), pelvis and abdomen [11,23], and retroperitoneal lymph node [11,23,24]. Furthermore, extra-abdominal lymph nodes such as para-aortic, [23,25,26], supraclavicular [11] and cervical lymph nodes [26][27][28] may be involved.…”

“…Furthermore, extra-abdominal lymph nodes such as para-aortic, [23,25,26], supraclavicular [11] and cervical lymph nodes [26][27][28] may be involved. Distant hematogenous metastases develop in the bones [29][30][31], lungs (15%) [24], liver [29,31], kidneys [29], adrenal glands [31], mammary glands [32], cranium, brain, dura mater and intra-axial [24,33,34], pancreas [29], heart and skin [32]. There are also a number of other uncommon distant sites that have been reported: eye, placenta, central airways (bronchus-trachea), bladder (17%), pleura (33%), spleen (20%), bowel (50%) [22,35], and neurologic involvement such as carcinomatous meningitis [24,33,34].…”

“…Distant hematogenous metastases develop in the bones [29][30][31], lungs (15%) [24], liver [29,31], kidneys [29], adrenal glands [31], mammary glands [32], cranium, brain, dura mater and intra-axial [24,33,34], pancreas [29], heart and skin [32]. There are also a number of other uncommon distant sites that have been reported: eye, placenta, central airways (bronchus-trachea), bladder (17%), pleura (33%), spleen (20%), bowel (50%) [22,35], and neurologic involvement such as carcinomatous meningitis [24,33,34]. Our literature search did not reveal vaginal metastasis from OD, as reported in our patient, explaining our interest for the case.…”