Cauda equina syndrome due to leptomeningeal carcinomatosis of the ovary

Abstract

Background Serous cystadenocarcinoma is the most common malignant ovarian tumor. 85% are associated with extraovarian spread at the time of diagnosis. Cauda equina syndrome due to leptomeningeal ovarian serous cystadenocarcinomatosis is rare. Case A 66-year-old female with stage IV ovarian papillary serous cystadenocarcinoma presented with perianal numbness and sphincter dysfunction. On exam she had decreased anal tone with saddle anesthesia. Her MRI did not demonstrate any leptomeningeal involvement. CSF showed malignant cells consistent with metastatic ovarian adenocarcinoma. She received intrathecal methotrexate, capecitabine and bevacizumab. She expired 8 months later. Conclusion Ovarian cancer metastasizng to the cauda equina should be highly suspected based on the clinical presentation alone, even with unremarkable imaging studies. CSF cytology should be checked in cases presenting with cauda equina syndrome.