May 29, 2020
Ramez N. Eskander, MD


Case Overview:

Initial Presentation

  • A 68-year-old postmenopausal woman presented with fatigue, urinary frequency, early satiety, abdominal bloating and distention
  • PMH: HTN, medically treated with lisinopril
  • SH: retired; grandmother of 3; never-smoker; social alcohol use
  • PE: abdominal distention, bloating, and a positive fluid wave test; otherwise unremarkable


Clinical work-up

  • Pelvic exam with transvaginal ultrasound showed a right ovarian mass
  • Chest/abdomen/pelvis CT with contrast revealed a right adnexal 5.3-cm complex mass, a suspicious intraparenchymal liver lesion, retroperitoneal lymph node enlargement and concurrent pleural effusion
  • Lymph node and adnexal mass biopsy confirmed high-grade, epithelial ovarian cancer; positive cytology of pleural effusion
    • T1N1M1
  • Germline molecular testing showed BRCA1/2 wild-type, HRD+
  • CA-125, 438 U/mL
  • ECOG: 1

Treatment

  • Patient underwent TAH/BSO, lymph node dissection, with suboptimal debulking; residual disease 1.3 cm
  • Paclitaxel/carboplatin/bevacizumab + maintenance bevacizumab
    • After 3 cycles, patient underwent second debulking surgery, R0
  • Continued on bevacizumab for 6 more cycles
    • Achieved partial response, post treatment CA-125, 40 U/mL
       

Follow-up

  • At 3 months
    • CA-125, 18 U/mL
    • Chest/abdomen/pelvis CT showed no gross pelvic masses or nodes
    • Pelvic exam was unremarkable