Ovarian Cancer Relapse Causing Fluid Around the Heart

What happened, in summary

A 51-year-old woman sought care in 2010 for 2 months of lower abdominal pain, abdominal heaviness, and loss of appetite. Imaging showed masses in both ovaries with ascites, and her CA-125 was 86 IU/mL. She underwent hysterectomy, removal of both ovaries and fallopian tubes, omentectomy, and tumor-reduction surgery. Pathology confirmed high-grade serous ovarian carcinoma involving both ovaries, nearby tissue, the right fallopian tube, and the omentum. The cancer was Stage IIIC, and some disease remained near the rectosigmoid and ileocecal bowel regions.

She completed 6 cycles of paclitaxel and carboplatin every 3 weeks. Imaging and clinical review found no disease immediately after chemotherapy, and CA-125 fell to 7.9 IU/mL. She continued regular follow-up.

Seven years later, she developed 20 days of breathing difficulty, chest pain, fatigue, and leg swelling. A hemorrhagic pericardial effusion was compressing her heart. Doctors drained 200 mL of fluid, then created a surgical pericardial window and removed another 300 mL. Cytology and immunostaining confirmed that the cancer around the heart came from the ovarian primary.

Four weeks later, she restarted paclitaxel and carboplatin. Testing showed isolated PMS2 loss and 2 BRCA1 variants of uncertain significance, which were not established as disease-causing mutations. She completed chemotherapy and was alive on olaparib maintenance at the latest follow-up.