PMC9082594_01
(A,B) Initial T1-weighted MRI with contrast demonstrates a large right posterior temporal heterogeneously enhancing lesion with scattered calcifications and surrounding vasogenic edema that appeared to arise from the right tentorium. (C,D) Postoperative T1-weighted MRI with contrast demonstrates expected postoperative changes with minimal residual along the tentorium.
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F1
Given the nature of her symptomatology, there was a concern for disease recurrence with metastases to the brain prompting MRI, which demonstrated a large right posterior temporal heterogeneously enhancing lesion with scattered calcifications and surrounding vasogenic edema that appeared to arise from the right tentorium (Figures 1A,B). The intracranial lesion was morphologically similar to her omental biopsy three years prior with an identical immunoprofile upon comparison (Supplementary Figures 1A-H). Postoperative MRI of the brain demonstrated expected changes with minimal residual along the tentorium (Figures 1C,D).
Histopathology and immunohistochemistry of the intracranial metastatic serous carcinoma. (A) H&E stain at 100x magnification with nests and small papillae of pleomorphic tumor cells infiltrating brain parenchyma. (B) H&E stain at 200 x magnification demonstrating pleomorphic carcinoma with a well-formed psammoma body. (C) H&E stain at 200 x magnification demonstrating numerous psammoma bodies. (D) WT-1 immunostain at 200 x magnification demonstrating strong nuclear positivity. (E) p53 immunostain at 200 x magnification strongly marking the nuclei of all tumor cells. (F) Cytokeratin-7 immunostain at 200 x magnification with strong cytoplasmic reactivity. (G) p16 immunostain at 200 x magnification with strong nuclear positivity. (H) CA-125 immunostain at 200 x magnification with strong cytoplasmic reactivity.
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F2
Histopathology showed nests and small papillae of pleomorphic tumor cells, abundant psammoma bodies, and extensive necrosis (Figures 2A-C). Immunohistochemistry demonstrated WT-1, p53, cytokeratin-7, p16, and CA-125 positivity (Figures 2D-H).
(A-D) Repeat T1-weighted MRI with contrast three years later with interval development of extensive diffuse enhancing dural nodularity, numerous avidly enhancing supratentorial and infratentorial lesions, enhancement of the bilateral trigeminal nerves, internal auditory canals, and exit wound from the surgical site into the posterior aspect of the right-sided neck musculature consistent with diffuse leptomeningeal dissemination (arrows indicate internal auditory canals).
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F3
Repeat MRI demonstrated interval development of extensive diffusely enhancing dural nodularity, numerous avidly enhancing supratentorial and infratentorial lesions, enhancement of the bilateral trigeminal nerves, internal auditory canals, and exit wound from the surgical site into the posterior aspect of the right-sided neck musculature, consistent with diffuse leptomeningeal dissemination (Figure 3).