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A Case of Metastatic Uterine Tumor Originating from Small-Cell Lung Cancer (SCLC) Mimicking Uterine Sarcoma. Case Rep Obstet Gynecol 2022; 2021:1809017. [PMID: 35127187 PMCID: PMC8325592 DOI: 10.1155/2021/1809017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/15/2021] [Indexed: 12/04/2022] Open
Abstract
Metastatic uterine tumors originating from extragenital cancers are a rare clinical occurrence. We report a case of metastatic uterine cancer derived from small-cell lung cancer (SCLC) that necessitated surgical treatment. The patient was a 59 y/o female who had undergone chemotherapy for stage IIIB SCLC. A 15 cm uterine tumor lesion was initially detected on CT scans. The patient had previously been diagnosed with uterine fibroids, but compared to the most recent CT scans taken one and a half months earlier, imaging diagnosis revealed a sudden increase in the size of the tumor when compared to the 8 cm myoma fibroid noted previously. Additional work-up with MRI scans revealed T2-enhanced images of a tumor that had almost completely invaded the myometrium; the tumor presented with marked diffusion-weighted enhancement, and a flow void was noted within the tumor. A differential diagnosis of uterine sarcoma was considered, but due to the lack of focal hemorrhage or necrosis findings on MRI imaging, the possibility of differential diagnosis of metastatic SCLC was also noted. As the patient was experiencing abdominal symptoms including abdominal distension and tenderness due the tumor, a simple hysterectomy and bilateral salpingo-oophorectomy were performed to palliate the symptoms. During the surgical procedures, intra-abdominal findings noted peritoneal dissemination while intraoperative cell cytology diagnosis of ascites revealed small-cell cancer. The final histopathological diagnosis likewise revealed metastatic small-cell cancer from the primary lung cancer. The clinical status of the lung cancer was evaluated as progressive disease (PD), and a change in chemotherapy regimen was necessitated. Further disease progression was noted on CT scans at 2 and a half months after surgery, and with gradual systemic disease progression, the patient died of disease at 3 months postsurgery. Initial evaluation of rapidly enlarging uterine tumors should include a differential diagnosis of uterine sarcoma; additionally, it is necessary to also consider the rare possibility of metastatic disease as in the present case with a clinical history of extragenital malignancy.
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Xu L, Li K, Chen X, Chen B, Li J, Wu L. Next-generation sequencing assisted diagnosis of cervical metastasis in EGFR-mutated lung adenocarcinoma: A case report. Thorac Cancer 2021; 12:2622-2627. [PMID: 34505336 PMCID: PMC8487810 DOI: 10.1111/1759-7714.14143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 12/18/2022] Open
Abstract
EGFR mutation has been detected in more than half of non-small cell lung cancer (NSCLC) patients in Asia. Lung cancer is the main cause of malignant tumor-related death worldwide. Although distant metastases often occurs in patients with advanced NSCLC, uterine cervical metastasis is rare. Here, we report a case of EGFR-mutated lung adenocarcinoma with cervical metastasis. A 63-year-old female with known lung adenocarcinoma was found to have abnormal vaginal bleeding during osimertinib follow-up visits. Immunohistochemical (IHC) staining and next-generation sequencing (NGS) of the biopsy sample from the uterine cervical tumor confirmed metastatic dissemination from the primary lung malignancy. NGS assisted the diagnosis of uterine cervical metastasis from the primary lung. This is another major clinical application of NGS in addition to medication guidance and identification of drug resistance mechanisms.
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Affiliation(s)
- Li Xu
- Second Department of Thoracic Medicine, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Kang Li
- Second Department of Thoracic Medicine, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaoyan Chen
- Clinical Pathology Diagnostic Center, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Bolin Chen
- Second Department of Thoracic Medicine, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jia Li
- Second Department of Thoracic Medicine, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Lin Wu
- Second Department of Thoracic Medicine, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Kobayashi T, Kanda S, Fukushima T, Noguchi T, Sekiguchi N, Koizumi T. Response to lorlatinib on a patient with ALK-rearranged non-small cell lung cancer harboring 1151Tins mutation with uterine metastasis. Thorac Cancer 2021; 12:2275-2278. [PMID: 34184417 PMCID: PMC8365006 DOI: 10.1111/1759-7714.14056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022] Open
Abstract
We describe a case of an anaplastic lymphoma kinase (ALK)‐rearranged non‐small cell lung cancer with development of uterine metastasis after crizotinib and alectinib treatment. Gene analysis from the tissue of uterine metastasis revealed the presence of 1151Tins, which was considered to be a crizotinib and alectinib resistance mutation. Subsequent therapy with the third‐generation ALK inhibitor lorlatinib, but not ceritinib, showed antitumor activity for 1 year. The uterus is an uncommon site for metastasis from lung cancer, and our case indicated that serial gene analysis could provide new information about ALK inhibitor resistance.
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Affiliation(s)
- Takashi Kobayashi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shintaro Kanda
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshirou Fukushima
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takuro Noguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nodoka Sekiguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
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Sevinyan L, Illsley M, Haagsma B, Butler-Manuel S, Ellis P, Madhuri TK. Would extirpative pelvic surgery improve survival in gynecological metastases of lung cancer? Case report and review of the literature. Int Cancer Conf J 2020; 10:24-30. [PMID: 33489697 DOI: 10.1007/s13691-020-00441-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022] Open
Abstract
Lung cancer is the 3rd most common cancer in the UK and the numbers of new cases increase every year. In contrast to gastrointestinal tumours and breast cancer, lung cancer, metastases to the female genital tract are incredibly rare with only five cases reported with uterine metastases on review of the published English literature. We report an interesting case of successful ongoing management of metastatic lung cancer to the pelvis along with an extensive literature review. A 47-year-old lady with recurrent respiratory tract symptoms and chest pain was diagnosed with advanced stage non-small-cell lung cancer (Stage T4N2M1A). Five years following diagnosis and several cycles of chemotherapy and radiotherapy, aged 52, she complained of post-menopausal bleeding and pelvic discomfort. An endometrial biopsy confirmed a malignancy morphologically and immunohistochemically similar to her lung adenocarcinoma, in keeping with metastatic disease. She underwent robotic surgery to excise the pelvic organs and successfully gain local disease control. The patient remains clinically stable 3 years following hysterectomy. Although metastases of lung cancer to uterus are very rare, any patient with abnormal uterine bleeding with known cancer should be investigated thoroughly to rule out metastatic disease. Combined multimodal treatment as in this case may increase overall survival.
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Affiliation(s)
- Lusine Sevinyan
- Department of Gynae-Oncology, LEVEL B GOPD, Royal Surrey NHS Foundation Trust, Egerton Rd, Guildford, GU2 7XX UK
| | - Marianne Illsley
- Royal Surrey NHS Foundation Trust, Egerton Rd, Guildford, GU2 7XX UK
| | - Ben Haagsma
- Department of Histopathology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Simon Butler-Manuel
- Department of Gynae-Oncology, LEVEL B GOPD, Royal Surrey NHS Foundation Trust, Egerton Rd, Guildford, GU2 7XX UK
| | - Patricia Ellis
- Department of Gynae-Oncology, LEVEL B GOPD, Royal Surrey NHS Foundation Trust, Egerton Rd, Guildford, GU2 7XX UK
| | - Thumuluru Kavitha Madhuri
- School of Pharmacy & Biomolecular Sciences, University of Brighton, Brighton, UK.,Department of Gynae-Oncology, LEVEL B GOPD, Royal Surrey NHS Foundation Trust, Egerton Rd, Guildford, GU2 7XX UK
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Knox B, Dobrotwir A, Ades A. Isolated uterine metastasis from a lung adenocarcinoma. BMJ Case Rep 2019; 12:12/12/e232487. [PMID: 31818894 DOI: 10.1136/bcr-2019-232487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 65-year-old woman was referred with an incidental finding of a flurodeoxyglucose-avid uterine lesion, following excision of a local lung adenocarcinoma. MRI had features concerning for an atypical fibroid or smooth muscle tumour of uncertain malignant potential. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathology demonstrated a leiomyoma infiltrated with adenocarcinoma consistent with a secondary lesion from the lung cancer. Among the small number of cases of uterine metastases of extra-pelvic primary cancers reported in the literature, those from lung cancers are very rare. Concerning features for an atypical fibroid included the patient's age and postmenopausal status, as well as positron emission tomography and MRI findings. A metastatic secondary cancer was not suspected. Diagnosis was only made after histopathological examination. This case represents a very unusual cause of a uterine mass. It demonstrates the importance of thorough preoperative work-up and accurate histopathological assessment.
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Affiliation(s)
- Benita Knox
- Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Andrew Dobrotwir
- Radiology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Alex Ades
- Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
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Anjali VR, Pandey R, Srivastava A, Rajeshwari M, Pandey D, Sharma MC. Sequential EGFR mutation and ALK rearrangement in adenocarcinoma lung, with rare metastasis to bilateral breast, ovary and endometrium. Respir Med Case Rep 2019; 28:100954. [PMID: 31720204 PMCID: PMC6838794 DOI: 10.1016/j.rmcr.2019.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022] Open
Abstract
With the advent of targeted therapies there was a paradigm shift in the treatment of metastatic adenocarcinoma of lung. Immuno-histopathology and molecular subtyping in metastatic adenocarcinoma lung have enabled personalized treatment for each patient. Oncogenic driver mutations in non-small cell lung cancer are commonly EGFR (Epidermal Growth Factor Receptor) gene mutation and ALK (Anaplastic Lymphoma Kinase) gene rearrangement, which are mutually exclusive. Almost 60-64% patients have oncogenic mutation, which are mutually exclusive. Here, we present a case with EGFR mutation and ALK gene rearrangement which was expressed sequentially and with metastasis to rarest sites bilateral breast, ovaries and endometrium. Even though presented with upfront metastatic disease, patient was treated with multiple lines of targeted agents, by which patient survived for 5 years with good quality of life.
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Affiliation(s)
- V R Anjali
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Rambha Pandey
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Astha Srivastava
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhu Rajeshwari
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Durgatosh Pandey
- Department of Surgical Oncology, Artemis Hospital, Gurgaon, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Unexpected endometrial metastasis of a primary lung adenocarcinoma. Radiol Case Rep 2018; 13:793-796. [PMID: 30002783 PMCID: PMC6041367 DOI: 10.1016/j.radcr.2018.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/13/2018] [Indexed: 11/23/2022] Open
Abstract
Following diagnosis of primary malignancies, subsequent workup includes evaluation for metastasis. Each malignancy, both location and histologic features, have statistically common and less common metastatic patterns. Metastatic lung adenocarcinoma typically involves lymph nodes, liver, brain, and bone. Very rarely can it involve the reproductive tract. Specifically, in females, multiple reported cases include ovarian metastasis. Even rarer, endometrial metastasis, such as this case report, has been reported. Even with usual staging utility of PET/CT, common things remain common; knowledge of common metastatic patterns can bias overall interpretation. This case is a reminder that despite our tendencies to focus on frequent patterns, even the rarest of metastatic patterns are still possible.
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Shibata M, Shizu M, Watanabe K, Takeda A. Uterine metastasis of lung adenocarcinoma under molecular target therapy with epidermal growth factor receptor tyrosine kinase inhibitors: A case report and review of the literature. J Obstet Gynaecol Res 2017; 44:352-358. [PMID: 29094453 DOI: 10.1111/jog.13493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/12/2017] [Indexed: 11/27/2022]
Abstract
A 63-year-old woman presented with abnormal vaginal bleeding. Her disease history was significant, and included advanced lung adenocarcinoma with a deletion mutation in exon 19 of the epidermal growth factor receptor (EGFR) gene, which was managed by concurrent chemoradiotherapy, followed by molecular targeted therapy with tyrosine kinase inhibitors (TKIs) for a two-year period. Contrast-enhanced computed tomography showed the enlargement of a previously suspicious myoma node, with peripheral enhancement. Hemorrhagic necrosis was also observed on magnetic resonance imaging. Transabdominal hysterectomy and bilateral salpingo-oophorectomy showed solitary intramyometrial metastatic lung adenocarcinoma with a second-site T790M gatekeeper mutation in exon 20 of the EGFR gene. In conclusion, uterine metastasis from lung adenocarcinoma can present a diagnostic challenge. The possibility of lung cancer metastasis should be considered when a uterine mass increases in size during treatment. Molecular analysis of the EGFR gene to detect mutations could provide useful information for planning the treatment strategy.
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Affiliation(s)
- Mayu Shibata
- Departments of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Masato Shizu
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Kazuko Watanabe
- Department of Diagnostic Pathology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Akihiro Takeda
- Departments of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
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Rush SK, Toukatly MN, Kilgore MR, Urban RR. Metastases from lung adenocarcinoma within a leiomyoma: A case report. Gynecol Oncol Rep 2017; 20:27-29. [PMID: 28243626 PMCID: PMC5320049 DOI: 10.1016/j.gore.2017.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pulmonary adenocarcinoma rarely spreads to the gynecologic tract, and has not been fully reported to metastasize within a leiomyoma. CASE A 47 year-old woman with recurrent pulmonary adenocarcinoma was incidentally found to have a positron emission tomography (PET) avid pelvic mass at the time of restaging. She was also noted to be anemic, and reported significant vaginal bleeding. She was taken for an uncomplicated hysterectomy. She was unexpectedly found to have adenocarcinoma within a leiomyoma, consistent with metastasis from her primary pulmonary adenocarcinoma. CONCLUSION We report one of the first cases of pulmonary adenocarcinoma metastatic to a uterine leiomyoma. A personal history of cancer should always be considered in patients presenting with symptomatic leiomyoma.
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Affiliation(s)
- Shannon K Rush
- University of Washington Medical Center, Department of Obstetrics and Gynecology, Seattle, WA, United States
| | - Mirna N Toukatly
- University of Washington Medical Center, Department of Pathology, Seattle, WA, United States
| | - Mark R Kilgore
- University of Washington Medical Center, Department of Pathology, Seattle, WA, United States
| | - Renata R Urban
- University of Washington Medical Center, Division of Gynecologic Oncology, Seattle, WA, United States
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Assouline P, Léger-Ravet MB, Saffroy R, Hamelin J, Bénissad A, Husleag P, Lemoine A, Oliviéro G. [Breast metastases from lung cancers with the EGFR mutation]. Rev Mal Respir 2016; 34:61-65. [PMID: 27282326 DOI: 10.1016/j.rmr.2016.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/27/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The breast is a rare site for metastases from lung cancers. Their occurrence in patients with adenocarcinoma which has the EGFR mutation is exceptional. In this context, it is sometimes difficult to differentiate a second primary breast cancer from a breast metastasis. OBSERVATIONS We report the cases of two patients who developed breast metastases from lung adenocarcinoma that was TTF1 positive with a deletion of exon 19 of the EGFR gene. A non-smoking woman of Asian origin, presented with a solitary breast metastasis 29 months after being established on first-line chemotherapy. The second case was a Caucasian patient who was an active smoker presented with tumor progression with multiple metastases including involvement of both breasts 10 months after the start of treatment with a tyrosine kinase inhibitor. In both, tumor cells from the breast showed positive immunostaining for TTF1 and genotyping detected the presence of the deletion of exon 19 of the EGFR gene. CONCLUSION In patients with lung adenocarcinoma and EGFR mutation, immunohistochemical examination, including TTF1 and genotyping of synchronous breast tumour, is needed to confirm its metastatic nature and to guide treatment.
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Affiliation(s)
- P Assouline
- Service de pneumologie et d'oncologie thoracique, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau cedex 01, France.
| | - M-B Léger-Ravet
- Service d'anatomie et de cytologie pathologiques, groupe hospitalier Nord Essonne, 91160 Longjumeau cedex 01, France
| | - R Saffroy
- Service de biochimie et d'oncogénétique, hôpital Paul-Brousse, Assistance publique-Hôpitaux de Paris, 12, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - J Hamelin
- Service de biochimie et d'oncogénétique, hôpital Paul-Brousse, Assistance publique-Hôpitaux de Paris, 12, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - A Bénissad
- Service d'imagerie médicale, groupe hospitalier Nord Essonne, 91160 Longjumeau cedex 01, France
| | - P Husleag
- Service de pneumologie et d'oncologie thoracique, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau cedex 01, France
| | - A Lemoine
- Service de biochimie et d'oncogénétique, hôpital Paul-Brousse, Assistance publique-Hôpitaux de Paris, 12, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - G Oliviéro
- Service de pneumologie et d'oncologie thoracique, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau cedex 01, France
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