Tuberc Respir Dis.  2014 Dec;77(6):258-261. 10.4046/trd.2014.77.6.258.

Bilateral Ovarian Metastases from ALK Rearranged Non-Small Cell Lung Cancer

• Lee KA
• Lee JS
• Min JK
• Kim HJ
• Kim WS
• Lee KY

• KMID: 1842993
• DOI: http://doi.org/10.4046/trd.2014.77.6.258

Abstract

Anaplastic lymphoma kinase (ALK) rearrangement, is a kind of driver mutation, accounts for 3%-5% of non-small cell lung cancer (NSCLC). NSCLC patients harboring ALK fusion genes have distinct clinical features and good response to ALK inhibitors. Metastasis from lung cancer to the ovary has rarely been known. We report a case of a 54-year-old woman with bilateral ovarian metastases from ALK rearranged NSCLC. She underwent bilateral salpingo-oophorectomy for ovary masses, which were progressed after cytotoxic chemotherapy although primary lung mass was decreased. Histopathological examination of the ovary tumor showed characteristic adenocarcinoma patterns of the lung and ALK rearrangement.

Keyword

Anaplastic Lymphoma Kinase; Carcinoma, Non-Small-Cell Lung; Neoplasm Metastasis; Ovary

MeSH Terms

Adenocarcinoma
Carcinoma, Non-Small-Cell Lung*
Drug Therapy
Female
Humans
Lung
Lung Neoplasms
Lymphoma
Middle Aged
Neoplasm Metastasis*
Ovary
Phosphotransferases
Phosphotransferases

Figure

• 

  Figure 1 Computed tomography scan showing a 5.4-cm- (A) and 3.3-cm-sized (B) left lower lobe masses with left hilar (C) and subcarinal lymphadenopathies.

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  Figure 2 Bilateral ovarian metastases of lung cancer at the initial positron emission tomography-computed tomography scan showing hypermetabolic activity in both ovaries (maximum standardized uptake value: right 15.7, left 13.4).

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  Figure 3 The ovary showing thick trabeculae or nests of solid variant adenocarcinoma (H&E stain, ×100). Inset: The tumor cells are positive for nuclear immunoreactivity to TTF-1 (×400).

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  Figure 4 (A) The tumor cells of the ovary showing strong ALK immunostaining positivity (×400). (B) Positive split signal patterns using ALK break-apart fluorescent in situ hybridization probe.

Reference

1. Soda M, Choi YL, Enomoto M, Takada S, Yamashita Y, Ishikawa S, et al. Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer. Nature. 2007; 448:561–566.

2. Sasaki T, Rodig SJ, Chirieac LR, Janne PA. The biology and treatment of EML4-ALK non-small cell lung cancer. Eur J Cancer. 2010; 46:1773–1780.

3. Kwak EL, Bang YJ, Camidge DR, Shaw AT, Solomon B, Maki RG, et al. Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med. 2010; 363:1693–1703.

4. Shaw AT, Kim DW, Nakagawa K, Seto T, Crino L, Ahn MJ, et al. Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med. 2013; 368:2385–2394.

5. Frampton JE. Crizotinib: a review of its use in the treatment of anaplastic lymphoma kinase-positive, advanced non-small cell lung cancer. Drugs. 2013; 73:2031–2051.

6. Hayashi H, Okamoto I, Tanizaki J, Tanaka K, Okuda T, Kato A, et al. Cystic brain metastasis in non-small-cell lung cancer With ALK rearrangement. J Clin Oncol. 2014; 32:e122–e124.

7. Alvarado-Cabrero I, Rodriguez-Gomez A, Castelan-Pedraza J, Valencia-Cedillo R. Metastatic ovarian tumors: a clinicopathologic study of 150 cases. Anal Quant Cytopathol Histpathol. 2013; 35:241–248.

8. Jung YE, Lee JW, Kim BG, Bae DS. Ovarian metastasis from pulmonary adenocarcinoma. Obstet Gynecol Sci. 2013; 56:341–344.

9. Fujiwara K, Ohishi Y, Koike H, Sawada S, Moriya T, Kohno I. Clinical implications of metastases to the ovary. Gynecol Oncol. 1995; 59:124–128.

10. 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.

11. Doebele RC, Lu X, Sumey C, Maxson DA, Weickhardt AJ, Oton AB, et al. Oncogene status predicts patterns of metastatic spread in treatment-naive nonsmall cell lung cancer. Cancer. 2012; 118:4502–4511.

12. Yang P, Kulig K, Boland JM, Erickson-Johnson MR, Oliveira AM, Wampfler J, et al. Worse disease-free survival in never-smokers with ALK+ lung adenocarcinoma. J Thorac Oncol. 2012; 7:90–97.