Title: Carcinoma Lung Presenting As Ovarian Mass – A Case Report
Authors: Dr Sajeed. A, Dr Geethi M H, Dr John Joseph, Dr Susan Mathews, Dr Preethi.T.R
DOI: http://dx.doi.org/10.18535/jmscr/v3i11.48
Differentiation of primary versus secondary malignant neoplasms of the ovary presents a diagnostic dilemma particularly when the patient presents initially with a large ovarian mass. The secondary tumors usually arise from digestive system or breast, while a primary in the lung is very rare. We report the case of a 28 year old lady who presented with bilateral adnexal complex mass and a left sided pleural effusion on the preoperative computed tomography scan, subsequently underwent a staging laparotomy with removal of the mass, total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, appendisectomy, pouch of douglas and bladder peritonectomy. Initial pathologic examination of the specimen suggested primary mucinous adenocarcinoma (Cytokeratin 7 (CK7) positive and CK20 negative). No Gastrointestinal (GI) tract primary and pleural fluid was negative for malignant cells. The patient was referred to our centre after initiation of chemotherapy in the line of a primary ovarian malignancy. The pathology review at our centre showed morphology and IHC more in favour of a metastatic lesion from a lung primary. (CK7+, TTF-1+ and Napsin+, CK 20-, CDX2- and PAX 8- ). Repeat CT Chest revealed a lobulated mass left lower lobe and diffuse irregular pleural thickening. Chemotherapy was changed for the primary lung lesion. Our case report focuses on the clinical and pathologic diagnostic challenge of distinguishing secondary from primary ovarian neoplasms as well as locating the site of primary. Need and usefulness of a complete immunohistochemical profile is also stressed upon. Keywords: secondary ovarian neoplasm, lung primary, immunohistochemistry 1. Shi Y, Ye D, Lu W, Zhao C, Xu J, Chen L. Histological classification in 10288 cases of ovarian malignant tumors in China. Zhonghua Fu Chan Ke Za Zhi 2002, 37(2):97–100. 2. Vang R, Ronnet BM. Metastatic and miscellaneous primary tumors of the ovary. In Gynecologic Pathology. 1st edition. Edited by Nucci MR, Oliva E. Philadelphia: Churchill Livingstone Elsevier; 2009:539–614. 3. Hart WR: Diagnostic challenge of secondary (metastatic) ovarian tumors simulating primary endometrioid and mucinous neoplasms. Pathol Int 2005, 55(5):231–243. 4. Riitta Antila, Jyrki Jalkanen, Oskari Heikinheimo. Comparison of secondary and primary ovarian malignancies reveals differences in their pre- and perioperative characteristics. Gynecologic Oncology 2006;101:97–101. 5. Fujiwara K, Ohishi Y, Koike H, Sawada S, Moriya T, Kohno I. Clinical implications of metastases to the ovary. Gynecol Oncol 1995;59:124–8. 6. Incidence of metastasis to the ovaries from nongenital tract primary tumors. Richard G. Moore, Maureen Chung, Cornelius O. Granai, Walter Gajewski, and Margaret M. Steinhoff. Gynecologic Oncology 2004;93:87–91. 7. Lerwille MF, Young RH. Metastatic Tumors of the Ovary. In Blaustein’s Pathology of the Female Genital Tract (6th edn),Kurman RJ, Ellenson LH, Ronnett BM (eds). Springer-Verlag:New York, NY, 2011. 8. Irving JA, Young RH. Lung carcinoma metastatic to the ovary: a clinicopathologic study of 32 cases emphasizing their morphologic spectrum and problems in differential diagnosis.Am J Surg Pathol 2005;29:997–1006. 9. K. Y. Yeh, J. W. C. Chang, S. Hsueh, T. C. Chang, and M. C.Lin, “Ovarian metastasis originating from bronchioloalveolarcarcinoma: a rare presentation of lung cancer,” Japanese Journal of Clinical Oncology 2003; vol. 33, no. 8:404–407. 10. Bishop JA, Sharma R, Illei PB. Napsin A and thyroid transcription factor-1 expression in carcinomas of the lung, breast, pancreas, colon, kidney, thyroid, and malignant mesothelioma. Hum Pathol 2010;41(1):20–25.Abstract
References