Date: 2023-01-15

This is regarding Mrs. Muna Shrestha, a 59 year old female patient, a diagnosed case of ovarian
carcinoma. She underwent TAH BSO Subopitmal debulking of tumor elsewhere on 2020-08-14.
Histopathology reported Serous Cystadenocarcinoma of Ovary. She had no chemotherapy
immediately following that surgery. She came to our hospital CECT Abdomen and pelvis was
done on 2020-10-24. It reported recurrence with peritoneal deposits. MDT consensus decided
for NACT followed by secondary debulking surgery. She received NACT Nanoxel + Carboplatin 2
cycles and underwent Secondary cytoreductive surgery (vault mass removal + bilateral pelvic LN
dissection + Para aortic LN dissection + total omentectomy:) completion of surgery on 2020-12-
29. Four more cycles of adjuvant chemotherapy was given, sixth cycle completed on 2021-04-
23. She was advised for HRD genetic mutation test but due to social and financial cause she was
not able to do that. She was in 3 monthly regular follow up. She was in complete remission for
one and half years. She developed weakness of right upper and lower limb; right side
hemiparesis from about last 2 months. She had had seizure episodes 3 times, last episode on
2023-01-11. She underwent Neurologist Consultation. Her CE MRI Brain, on 2023-01-11, has
reported well defined intense peripheral and central enhancing mass lesion in left Frontal lobe,
size 2.0 x 1.8 x 1.5 cm with surrounding extensive perilesional edema causing contralateral
midline shift. MRS study suggestive of Neoplastic etiology, probably brain metastasis. Her CECT
Chest and Abdomen on 2023-01-12, has reported no mass lesion in chest, abdomen bilateral
breasts and visualized skeleton. She has solitary left frontal metastatic lesion with no evidence
of disease recurrence in chest abdomen or elsewhere in body. Patient party want to seek
second expert opinion. We are referring her to you for treatment with curative intent.