Ovarian metastasis from lung adenocarcinoma with ALK-positive rearrangement detected by next generation sequencing: A case report and literatures review

Figures & data

Figure 1. Shows the initial assessment before treatment by means of computed tomography (CT) scan of chest with contrast. The arrows are that: (A) left lower lobe masses (B) mediastinal lymphadenopathies (C) pleural metastasis.

Figure 2. The cytological examination revealed adenocarcinoma cells. Wright-Giemsa Stain (10 × 40) is used in both left and right panel.

Figure 3. Shows the response at the different evaluation time. The panels mean that: (A) The response evaluation of primary tumor after 2 courses chemotherapy is partial response (PR). The arrow in panel A shows the residual mass after 2 courses first-line chemotherapy. (B) The response of primary tumor after 4 courses chemotherapy is complete response (CR). (C) The response of primary tumor after 6 courses chemotherapy is CR. (D) Response before the last maintenance therapy was evaluated and stable disease persists.

Figure 4. The panels means that: (A) CT scan showed left ovarian metastasis. The red arrow in panel A shows the ovarian metastatic mass, which diameter is about 10 cm. (B and C) There is no evidence of progression on regular follow-up examination.

Figure 5. The panels means that: (A) The pathological diagnosis of the specimens was metastatic pulmonary adenocarcinoma. (H-E staining 10 × 40) (B) TTF-1 is positive in IHC staining. (C) Napsin A is positive in IHC staining.

Table 1. Patients with metastasis in non-small cell lung cancer who harboring ALK rearrangement.

Case no.	Authtor	Age	Sex	Smoking history	Histologic finding	EGFR status	ALK status	Metastatic site
1	Wang et al.[11]	33	F	Never	Adenocacinoma	−	+	Left Ovarian
2	Lee et al.[12]	54	F	2.5 pack-year	Adenocacinoma	−	+	Bilateral Ovarian
3	Fujiwara et al.[13]	39	F	1 pack per-day	Adenocacinoma	−	+	Bilateral Ovarian
4	West et al.[14]	50	F	Not given	Adenocacinoma	−	+	Bilateral Ovarian
5	Choi et al.[15]	35	F	Never	Adenocacinoma	−	+	Uterine Cervix
6	Diem et al.[16]	62	F	Never	Adenocacinoma	−	+	Gastric
7	Qiao et al.[17]	48	F	Never	Adenocacinoma	−	+	Left Ovarian

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Yeh K-Y, Chang JW-C, Hsueh S, Chang T-C, Lin M-C. Ovarian metastasis originating from bronchioloalveolar carcinoma: a rare presentation of lung cancer. Jpn J Clin Oncol. 2003; 33(8):404-7; PMID: 14523061; https://doi.org/10.1093/jjco/hyg078

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Wang W, Wu W, Zhang Y. Response to crizotinib in a lung adenocarcinoma patient harboring EML4-ALK translocation with adnexal metastasis: A Case Report. Medicine. 2016; 95(30):e4221; PMID: 27472693; https://doi.org/10.1097/MD.0000000000004221

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Lee KA, Lee JS, Min JK, Kim HJ, Kim WS, Lee KY. Bilateral ovarian metastases from ALK rearranged non-small cell lung cancer. Tuberc Respir Dis (Seoul). 2014; 77(6):258-61; PMID: 25580142; https://doi.org/10.4046/trd.2014.77.6.258

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Fujiwara A, Higashiyama M, Kanou T, Tokunaga T, Okami J, Kodama K, Nishino K, Tomita Y, Okamoto I. Bilateral ovarian metastasis of non-small cell lung cancer with ALK rearrangement. Lung Cancer. 2014; 83(2):302-4; PMID: 24360322; https://doi.org/10.1016/j.lungcan.2013.11.022

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West AH, Yamada SD, MacMahon H, Acharya SS, Ali SM, He J, Lukas RV, Miller VA, Salgia R. Unique metastases of ALK mutated lung cancer activated to the adnexa of the uterus. Case Rep Clin Pathol. 2014; 1(2):151; PMID: 25541622; https://doi.org/10.5430/crcp.v1n2p151

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Choi S, Park CK, Kim SY, Yoon HK, Ro SM, Nam Y. Uterine cervix metastasis in lung adenocarcinoma with Anaplastic Lymphoma Kinase rearrangement. Soonchunhyang Medical Science (SMS). 2015; 21(2):142-5; https://doi.org/10.15746/sms.15.033

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