Li Huixin, Chen Yan, Wang Yingchun, Zhou Lin, Tian Zhongfu, Liu Mengyu, Li Yang, Xu Hanzi, Wu Wangfei, Gong Zhen
Department of Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.
Department of Pathology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
Transl Cancer Res. 2022 Sep;11(9):3391-3399. doi: 10.21037/tcr-22-273.
Ovarian metastasis is an extremely rare condition in patients with lung adenocarcinoma. Lung adenocarcinoma patients with ovarian metastases were difficult to distinguish from primary ovarian cancer. Anaplastic lymphoma kinase () gene rearrangement is only found in 3-7% of patients with lung cancer. It is worth noting that the incidence of lung cancer with ovarian metastasis is extremely low, however, rearrangement is often reported in these cases. Here we reported a young woman, aged 23 years, with -positive lung adenocarcinoma and ovarian metastasis.
The patient underwent laparoscopic bilateral ovarian tumor resection after discovering an abdominal mass accidentally. A series of lung adenocarcinoma-specific immunohistochemical features were detected postoperatively by immunohistochemistry (IHC) analysis. Then extensive-stage metastatic masses of different sizes were identified by 2-deoxy-2-[18F]fluoro-d-glucose (18F-FDG) positron emission tomography combined with low-dose computed tomography (PET/CT), among which the largest nodule was 1.7 cm × 1.4 cm located in the middle lobe of the right lung. Genetic testing of the paraffin tissue DNA revealed the fusion mutation of (E14:A20) gene. The patient was pathologically diagnosed with lung adenocarcinoma with bilateral ovarian metastasis, administered with oral alectinib [600 mg twice daily (bid)] and followed-up quarterly. Currently, the patient responded to alectinib stably, with a progression-free survival (PFS) of more than 12 months, and experienced no significant adverse events. In addition, we reviewed the publications associated with the characteristics of -positive lung cancer with ovarian metastases and the identification of primary and secondary ovarian tumors.
This case provides a meaningful reference for the possibility of adnexal metastases from lung cancer, particularly for -rearranged young female patients. In addition, this case highlights the advantages of IHC together with genetic testing for identifying origin sites of ovarian metastases and provides a promising treatment option.
卵巢转移在肺腺癌患者中极为罕见。伴有卵巢转移的肺腺癌患者很难与原发性卵巢癌相区分。间变性淋巴瘤激酶（ALK）基因重排在仅3%-7%的肺癌患者中被发现。值得注意的是，肺癌伴卵巢转移的发生率极低，然而，在这些病例中ALK重排却经常被报道。在此，我们报告了一名23岁的年轻女性，患有ALK阳性肺腺癌并伴有卵巢转移。
患者偶然发现腹部肿块后接受了腹腔镜双侧卵巢肿瘤切除术。术后通过免疫组织化学（IHC）分析检测到一系列肺腺癌特异性免疫组化特征。然后通过2-脱氧-2-[18F]氟-D-葡萄糖（18F-FDG）正电子发射断层扫描联合低剂量计算机断层扫描（PET/CT）发现了不同大小的广泛期转移灶，其中最大的结节位于右肺中叶，大小为1.7 cm×1.4 cm。石蜡组织DNA的基因检测显示ALK（E14:A20）基因融合突变。该患者经病理诊断为双侧卵巢转移的肺腺癌，口服阿来替尼[600 mg，每日两次（bid）]并每季度进行随访。目前，患者对阿来替尼反应稳定，无进展生存期（PFS）超过12个月，且未出现明显不良事件。此外，我们回顾了与ALK阳性肺癌伴卵巢转移特征以及原发性和继发性卵巢肿瘤鉴别相关的文献。
本病例为肺癌发生附件转移的可能性提供了有意义的参考，特别是对于ALK重排的年轻女性患者。此外，本病例突出了免疫组化联合基因检测在识别卵巢转移瘤起源部位方面的优势，并提供了一种有前景的治疗选择。
