Brain metastasis in two patients with stage IA papillary serous carcinoma of the uterus

•We report brain metastasis in stage IA UPSC which developed in the absence of adjuvant chemotherapy or vaginal cuff brachytherapy.•Both patients had local drop-metastasis which may be the site of seeding to the systemic circulation resulting in brain metastasis.•The benefit of adjuvant treatment in uterine papillary serous carcinoma should be further evaluated and improved.

We report two cases of brain metastasis in patients initially diagnosed with extremely early stage UPSC after extensive staging surgery. They did not receive either adjuvant chemotherapy or adjuvant pelvic or vaginal cuff radiation. At the same time that these patients were diagnosed with systemic metastasis, they both had a local “drop” metastasis in the vulva or the vaginal cuff. After the initial response to palliative chemotherapy, they both developed brain metastasis. The pattern of recurrence with the lack of adjuvant treatment underscores the urgent need in further evaluation of the potential benefits of adjuvant treatment, including chemotherapy and possibly in combination with radiation in this highly aggressive disease.