Cerebellar metastasis from ovarian carcinoma harboring PIK3CA-activating mutation: A “clear” explanation for an unexpected “vertigo”

Summary: Brain metastasis is a rare and generally late manifestation of an advanced-stage, high-grade serous ovarian carcinoma. Nowadays, the improved control of intra-abdominal disease by surgery and platinum-based chemotherapy results in a longer survival, allowing distant metastasis to implant and grow in the brain parenchyma also. Herein, we describe a unique case of cerebellar metastasis from a particular type of ovarian tumor, clear cell that initially presented as a FIGO Stage IC cancer. Surprisingly, 6 mo after surgery, the patient shows good general conditions with complete disappearance of symptoms and no evidence of recurrence. This relatively good biologic behavior may be explained by the presence of PIK3CA-activating mutation in exon 9 which as previously reported in the literature, may be associated with better prognosis. To the best of our knowledge, this is the first reported case of cerebellar metastasis from ovarian clear cell carcinoma. In the presence of neurological symptoms, both clinicians and pathologists must be aware of this rare possibility, to assure the patient correct management and effective therapeutic options. Generally, the prognosis of epithelial ovarian cancer patients with brain metastases is poor. PIK3CA mutations could be a good prognostic indicator in clear cell carcinomas.