Metastatic epithelial ovarian cancer to Meckel’s cave with leptomeningeal spread at time of diagnosis

BACKGROUND: Brain metastasis occurs in 1–2.5% of epithelial ovarian cancer (EOC) cases and carries a poor prognosis. Typically, brain metastases arise 2–3 years following the primary diagnosis of EOC. Malignant spread to the brain discovered at the time of initial ovarian cancer presentation is exceedingly rare with minimal reported cases in literature. CASE: This is a rare case of highly aggressive EOC in a previously healthy 32-year-old woman with evidence of brain, bone, and vertebral metastasis at the time of initial diagnosis. This is the first reported case of EOC with spread to Meckel’s cave with symptoms consistent with trigeminal nerve disruption. The disease rapidly progressed through radiation and front-line chemotherapy. CONCLUSION: This report highlights the first reported case of EOC with invasion of Meckel’s cave—present at time of diagnosis. Consistent with most cases in the literature of brain metastasis in the setting of EOC, our patient had a highly aggressive tumor associated with a poor prognosis. With better primary management of EOC, along with increased overall survival in EOC patients following spread to the brain secondary to multimodal therapies, we can continue to expect increasing numbers of brain metastasis with uncommon sites of recurrence.