PMC6304521_01
At initial presentation with altered mental status, CT head without contrast showed a left frontal mass (arrow) with surrounding edema (arrow head) and midline shift.
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A noncontrast CT of the head found extensive left frontoparietal vasogenic edema with mass effect of the underlying brain parenchyma and a left frontal mass-like density (Figure 1).
Surgical planning MRI with contrast shows an irregular left frontal mass (arrow) with surrounding edema (arrow head).
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An MRI of the head demonstrated a large mass in the left frontal lobe with thick enhancing borders and a 9-mm left-to-right midline shift (Figure 2).
CT of the chest, abdomen, and pelvis performed without contrast (due to allergy) to evaluate for primary malignancy. The only finding was retroperitoneal lymphadenopathy notably of the left para-aortic nodes posterior to the renal vein (arrow).
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A CT of the chest, abdomen, and pelvis performed that day showed lymphadenopathy behind and above the left renal vein with the dominant node measuring 1.7 cm (Figure 3).
Tumor involving the brain. High grade serous carcinoma in the brain, morphologically resembling the tumor seen in the fallopian tube (hematoxylin and eosin, 100x magnification).
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Pathology of the specimen revealed a large metastatic carcinoma of Mullerian origin with enlarged nuclei and nucleoli, abundant mitosis, and intraluminal necrosis (Figures 4 and 5).
Tumor involving the brain. PAX8 immunohistochemical stain shows similarly strong nuclear staining in the tumor (100x magnification).
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Pathology of the specimen revealed a large metastatic carcinoma of Mullerian origin with enlarged nuclei and nucleoli, abundant mitosis, and intraluminal necrosis (Figures 4 and 5).
Images from laparoscopic total hysterectomy and bilateral salpingo-oophorectomy. Right fallopian tube fimbria with darker appearance (arrow). Normal appearance of left fallopian tube (arrow head).
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The abdominal survey was otherwise normal (Figure 6).
Tumor involving the fallopian tube. High grade serous carcinoma at the surface of the fallopian tube (hematoxylin and eosin, 100x magnification).
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Final pathology revealed high grade serous carcinoma identified only at the fimbrial end of the right fallopian tube, measuring 0.6 cm (Figures 7 and 8).
Tumor involving the fallopian tube. PAX8 immunohistochemical stain shows strong nuclear staining in the tumor (100x magnification).
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Final pathology revealed high grade serous carcinoma identified only at the fimbrial end of the right fallopian tube, measuring 0.6 cm (Figures 7 and 8).