Brain MRI Findings in 57-Year-Old Female with Advanced Ovarian Cancer

Case at a Glance

A 57-year-old female with stage IV high-grade serous ovarian carcinoma presents with new multifocal brain lesions detected on follow-up MRI, raising concerns for possible metastatic disease versus other etiologies.

Patient's Story

The patient is a 57-year-old woman with a history of stage IV high-grade serous ovarian carcinoma currently receiving bevacizumab (Avastin) therapy every three weeks. Over the past four months, she has experienced intermittent headaches along with neck and shoulder stiffness. Despite these symptoms, she maintains an active lifestyle with daily walking and exercise routines. Recent laboratory studies showed an elevated CA-125 of 450 and a positive circulating tumor DNA test (Signatera) with a value of 1.4, suggesting active disease. Currently, imaging shows no evidence of cancer elsewhere in the body.

Initial Assessment

Follow-up brain MRI was ordered due to the patient's neurological symptoms and rising tumor markers in the context of her advanced ovarian cancer diagnosis. The patient was scheduled for routine oncology follow-up to discuss imaging findings and treatment planning.

The Diagnostic Journey

Brain MRI with gadolinium contrast revealed multiple tiny punctate foci of FLAIR hyperintensity and enhancement within bilateral cerebral white matter. These lesions were similar in size but slightly increased in number compared to a prior study from several months earlier. The differential diagnosis included late subacute multifocal infarcts, infectious/inflammatory processes, demyelinating lesions, or metastatic disease. Cerebrospinal fluid analysis was recommended for further characterization.

Final Diagnosis

Pending - multifocal brain lesions of uncertain etiology in patient with advanced ovarian carcinoma. Further evaluation with CSF analysis and oncology consultation required to determine if lesions represent metastatic disease versus other causes such as treatment-related vascular changes or paraneoplastic effects.

Treatment Plan

Immediate oncology consultation scheduled to review imaging findings and determine appropriate next steps. Consideration for lumbar puncture and CSF analysis as recommended by radiology. Continue current bevacizumab therapy pending further diagnostic clarification. Monitor neurological symptoms closely and consider neurology consultation if symptoms worsen.

Outcome and Follow-up

Patient scheduled for urgent oncology appointment to discuss MRI findings and plan further diagnostic workup. Close monitoring of neurological status and tumor markers planned. Treatment modifications may be necessary pending results of additional testing and final diagnosis of brain lesions.