Yan Run-Lan, Wang Jie, Zhou Jian-Ya, Chen Zhen, Zhou Jian-Ying
Department of Respiratory Diseases, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
Department of Pathology, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
World J Clin Cases. 2019 Jun 26;7(12):1515-1521. doi: 10.12998/wjcc.v7.i12.1515.
The female genital tract is an uncommon site of involvement for extra-genital malignancies. Ovarian metastases have been described as disseminations of lung adenocarcinoma; rare cases of secondary localizations in the cervix, adnexa, and vagina have also been reported in the literature. Here, we report two cases of advanced lung adenocarcinoma with female genital tract metastasis.
The first case was a 41-year-old woman with stage IV lung adenocarcinoma metastasizing to the cervix. Immunohistochemistry of the cervical biopsy specimen revealed thyroid transcription factor (TTF)-1(+), cytokeratin (CK)-7(+), and (CK)-20(-). Gene mutational analysis showed epidermal growth factor receptor (EGFR) L858R mutation in exon 21. She had a positive response to gefitinib, for both the pulmonary mass and cervical neoplasm. The second case was a 29-year-old woman who was diagnosed with stage IV lung adenocarcinoma with EGFR mutation. After 12 mo of treatment with icotinib, ovarian biopsy showed adenocarcinoma with CDX2(-), TTF-1(+++), PAX8(-), CK-7(+++), CK-20(++), and Ki67(15%+), accompanied with EGFR 19-del mutation and T790M mutation.
Immunohistochemistry and gene mutational testing have greatly helped in locating the initial tumor site when both pulmonary and female genital tract neoplasms exist.
女性生殖道是生殖器外恶性肿瘤较少累及的部位。卵巢转移瘤被描述为肺腺癌的播散；文献中也报道了宫颈、附件和阴道继发性转移的罕见病例。在此，我们报告两例晚期肺腺癌伴女性生殖道转移的病例。
第一例为一名41岁女性，IV期肺腺癌转移至宫颈。宫颈活检标本的免疫组化显示甲状腺转录因子（TTF）-1（+）、细胞角蛋白（CK）-7（+）和（CK）-20（-）。基因检测显示21外显子表皮生长因子受体（EGFR）L858R突变。她对吉非替尼治疗肺部肿块和宫颈肿瘤均有阳性反应。第二例为一名29岁女性，被诊断为IV期肺腺癌伴EGFR突变。接受埃克替尼治疗12个月后，卵巢活检显示腺癌，CDX2（-）、TTF-1（+++）、PAX8（-）、CK-7（+++）、CK-20（++）和Ki67（15%+），伴有EGFR 19号外显子缺失突变和T790M突变。
当肺部和女性生殖道均存在肿瘤时，免疫组化和基因检测有助于确定原发肿瘤部位。
