Multiple brain metastases in a patient with uterine papillary serous adenocarcinoma: Treatment options for this rarely seen metastatic brain tumor
A 71-year-old female underwent abdominal hysterectomy with bilateral salpingo-oopherectomy 2 years and 3 months ago. Histopathological examination of the biopsy specimen showed UPSAC. Adjuvant chemotherapy was given after the abdominal hysterectomy. The patient's Glasgow Coma Scale score was 12/15 at the time of admission to our hospital. She presented with a 20-day history of headache and left hemiparesis, and she could not walk or use her left arm and left hand. Cranial magnetic resonance iaging (MRI) showed three lesions; two were located in the parenchyma of the cerebellum and had perilesional edema. but had no shift effect or obstruction on the fourth ventricle and the third lesion was located in the right frontobasal frontal lobe, and caused a large hemispheric edema and subfalcine herniation []. All the three lesions exhibited contrast enhancement following gadolinium injection. The lesions’ characteristics are shown in Figures -.\nThe patient underwent frontal craniotomy with gross total extirpation of the tumor located in the right frontal lobe on September 12, 2012. There were no surgical complications, such as bleeding or adhesiveness adjacent to the brain tissue during the removal of the tumor. The other two lesions located in the posterior fossa were left untouched because they had no mass effect. Histopathological examination of the biopsy specimen was consistent with metastatic UPSAC [].\nThe patient was able to walk with the assistance of a walker, and underwent follow-up cranial computed tomography (CT) 2 days postsurgery [], which showed that there was no residual tumor in the frontal lobe, the midline shift and subfalcine herniation improved, and less edema than presurgery. The patient was followed-up for 9 months postsurgery and via telephone (last contact on May 14, 2013) reported that she was able to walk independently, and use her left arm and left hand without any difficulty, and that she had undergone 10 days whole cranial radiotherapy and chemotherapy at another hospital. The contrast enhanced cranial MRI was performed following these therapies on February 18, 2013. It showed no residual or recurrent lesion at the operation site, and no lesion at the cerebellum, which had had two lesions in previous MRI. In addition, the edema was remarkably lessened at the right cerebral hemisphere regarding preoperative and early postoperative period.