Encephalopathy revealing early ovarian cancer in a 73-year old woman – case report

Summary A 73-year-old women with early high-grade serous ovarian cancer (HGSOC) presented with neurologic deficit as first symptom indicating a paraneoplastic neurological syndrome. Resection of the tumor followed by steroid treatment improved the patient’s condition.

Clinical findings The patient initially presented at the stroke unit of our hospital with hemiparesis and aphasia. Symptoms started the day before. Repeated cCT and cMRI scans as well as electroencephalography and lumbar puncture did not reveal any etiology. No relevant pre-diagnosis was known. Within days, neurological symptoms aggravated resulting in a somnolent and apathetic patient.

Diagnosis Ultrasound and CT scan of the abdomen detected an unilocular cyst measuring 23cm in diameter most probably appendant to the right adnexa. Imaging did not show any signs of malignancy. CA125 level was elevated (1456U/ml) while CEA was in range.

Therapy and outcome After CT-controlled drainage of the cyst, the patient’s condition remained unimproved. Due to residual adnexal tumor mass, explorative median laparotomy with hysterectomy and bilateral adnexectomy was conducted. Except the cyst, no tumorous or infectious signs were seen intraabdominally. Histopathologic results revealed HGSOC of the right ovary based on borderline ovarian tumor (pT1c2). Although antineuronal antibodies (especially Anti-Hu) could not be detected, a paraneoplastic origin of the neurological symptoms seems plausible as surgical resection of tumor followed by steroid therapy improved the patient’s status. After a month in specialized rehabilitation unit, the patient was able to walk and talk. Depending on the neurological prognosis, completing surgery is recommended.

Publication History

Article published online:
11 October 2022