Devrim ÇABUK, Şener GEZER, İzzet YÜCESOY, Lale AKSOY, Seda Duman ÖZTÜRK, Sevgiye Kaçar ÖZKARA

Ovarian Metastasis of ALK Translocation-Positive LungAdenocarcinoma: A Case Report

Ovarian metastasis is substantially rare in non-small cell lung cancer (N-SCLC). Driver gene mutations, such as Anaplastic Lymphoma Kinase (ALK), are used in the diagnosis of N-SCLC and its metastases. Demonstration of ALK mutation in N-SCLC patients will be helpful for detecting ovarian metastasis and planning personalized therapy; however, there is a limited number of cases related to this topic. In this case, we present the diagnosis and treatment of ALK-positive non-small cell lung adenocarcinoma patient with ovarian metastasis. Crizotinib is the first-class tyrosine kinase inhibitor using for the treatment of ALK-positive N-SCLC. The ovarian metastasis has been treated with surgery while under Crizotinib treatment. The patient continues to receive crizotinib treatment and no new metastases were detected at the end of a one-year follow-up. The possibility of ovarian metastasis in female N-SCLC patients with ALK rearrangement should be kept in mind.

PDF

___

1. Fujiwara K, Ohishi Y, Koike H, Sawada S, Moriya T, Kohno I. Clinical implications of metastases to the ovary. Gynecol Oncol 1995;59(1):124–8.
2. 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(8):997–1006.
3. Fujiwara A, Higashiyama M, Kanou T, Tokunaga T, Okami J, Kodama K, et al. Bilateral ovarian metastasis of non-small cell lung cancer with ALK rearrangement. Lung Cancer 2014;83(2):302–4.
4. 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.
5. Mushi RT, Yang Y, Cai Q, Zhang R, Wu G, Dong X. Ovarian metastasis from non-small cell lung cancer with ALK and EGFR mutations: A report of two cases. Oncol Lett 2016;12(6):4361–66.
6. 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 (Baltimore) 2016;95(30):e4221.
7. Jing X, Li F, Meng X, Liu Z, Yu J, Liu B. Ovarian metastasis from lung adenocarcinoma with ALK-positive rearrangement detected by next generation sequencing: A case report and literatures review. Cancer Biol Ther 2017;18(5):279–84.
8. West AH, Yamada SD, MacMahon H, Acharya SS, Ali SM, He J, et al. Unique metastases of ALK mutated lung cancer activated to the adnexa of the uterus. Case Rep Clin Pathol 2014;1(2):151–4.
9. Sasano H, Sekine A, Hirata T, Iwamoto K, Itou Y, Itani H, et al. Ovarian Metastases from ALK-rearranged Lung Adenocarcinoma: A Case Report and Literature Review. Intern Med 2018;57(22):3271–75.
10.National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. NCCN 2017 v3. Accessed 10 February 2019. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf.
11.Sekine A, Kato T, Hagiwara E, Shinohara T, Komagata T, Iwasawa T, et al. Metastatic brain tumors from non-small cell lung cancer with EGFR mutations: distinguishing influence of exon 19 deletion on radiographic features. Lung Cancer 2012;77(1):64–9.
12.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(18):4502–11.
13.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(7153):561–6.
14.Shaw AT, Kim DW, Nakagawa K, Seto T, Crinó L, Ahn MJ, et al. Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med 2013;368(25):2385–94.
15.Solomon BJ, Mok T, Kim DW, Wu YL, Nakagawa K, Mekhail T, et al. First-line crizotinib versus chemotherapy in ALK-positive lung cancer. N Engl J Med 2014;371(23):2167–77.
16.Yeh KY, Chang JW, Hsueh S, Chang TC, Lin MC. Ovarian metastasis originating from bronchioloalveolar carcinoma: a rare presentation of lung cancer. Jpn J Clin Oncol 2003;33(8):404–7.
17.Suzuki A, Shijubo N, Yamada G, Ichimiya S, Satoh M, Abe S, et al. Napsin A is useful to distinguish primary lung adenocarcinoma from adenocarcinomas of other organs. Pathol Res Pract 2005;201(8-9):579–86.