bone involvement in epithelial ovarian cancer is very unusual , with several series noting an incidence of < 2% [ 1 , 2 ] .
a recently encountered ovarian cancer patient who was found to have significant bone involvement at the time of disease recurrence , after an extended treatment - free interval , emphasizes the potential risk of metastatic disease in such sites and suggests possible unique features associated with this event .
a 60-year - old female with a history of epithelial ovarian cancer was seen for a second opinion concerning management .
she had originally been diagnosed with , and treated for , this malignancy in 1998 . following initial
surgery and chemotherapy , the patient remained without evidence of disease until 2007 when documented recurrence within the peritoneal cavity led to an attempt at secondary surgical cytoreduction .
the patient experienced considerable bone marrow suppression from this regimen , presumably due ( at least in part ) to the residual effects of her prior chemotherapy .
the patient subsequently remained well until the fall of 2010 when she developed both lower pelvic and back pain .
a pelvic pet / ct scan revealed a pre - sacral mass with definite erosion of the cancer into the sacrum .
the mass was felt to be unresectable and a decision was made to initially treat her with a platinum - based combination chemotherapy program ( carboplatin plus pegylated liposomal doxorubicin ) , and to then consider surgery or local radiation therapy ( depending on the impact of the response to the cytotoxic therapeutic regimen ) .
one of the remarkable features of epithelial ovarian cancer is its localization in most patients to the peritoneal cavity during the majority of its natural history , despite potentially quite large tumor volumes contained within this region of the body .
it has been hypothesized that successful spread of the malignancy requires a variety of essential specific growth factors and nutrients found within the peritoneal cavity and peritoneal fluid .
however , it is also well recognized that women with advanced ovarian cancer who experience more prolonged survival have a greater likelihood of experiencing metastatic spread to additional locations , such as the central nervous system [ 1 , 2 ] .
it is possible that late - developing malignant clones have lost the essential requirement for external growth factor support in order to become established in distant sites .
it is also reasonable to hypothesize that these cancers have been present , but quiescent , in these regions of the body for long periods before they become clinically evident .
the patient presented in this report was known to have had epithelial ovarian cancer for 12 years prior to the documentation of metastatic spread to the bone , an observation consistent with other reports of the development of bone involvement as a late metastatic event in the natural history of the malignancy [ 1 , 2 , 4 , 5 , 6 ] .
it is relevant for clinicians caring for ovarian cancer patients to appreciate that although bone is a most unusual initial site of metastatic spread in this setting , bony involvement may become a more common feature in the increasing proportion of patients with this malignancy who are expected to experience extended survival ( > 45 years ) but who , unfortunately , are not expected to be cured of the disease process .
 bone involvement is uncommon in epithelial ovarian cancer . in this report , a case of bone metastases from ovarian cancer 
 is described and the potential risk factors for such a rare occurrence are discussed . 
 it is possible that such an event will become more common in the future as patients with advanced ovarian cancer experience prolonged survival but the cancer is not eliminated . 
Introduction
Case Report
Discussion