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

Abstract

Ovarian metastasis is an exceptionally rare condition in lung adenocarcinoma patients and is often difficult to distinguish from primary ovarian carcinoma. ALK (anaplastic lymphoma kinase) tyrosine kinase inhibitors elicit a significant objective response rate and are well-tolerated in advanced ALK-positive lung cancer. Hence, we report a case of a 41-year-old woman with ovarian metastases from NSCLC. After receiving a 6 course first line chemotherapy and 8 course maintenance therapy, the patient suffered acute abdominal pain, so surgery was performed. ALK rearrangement was detected by next generation sequencing, with a 13% abundance of ALK fusion. Crizotinib was administered, and the disease remained stable after 10 months of crizotinib therapy. Further, we reviewed the literature related to characteristics of metastatic ovarian malignancies that form from lung tumors, the utility of ALK inhibition for treating ALK-positive NSCLC, the molecular diagnosis of ALK rearrangement and the role of next generation sequencing for ALK rearrangement detection.

ALK rearrangement: a high-frequency alteration in ovarian metastasis from lung adenocarcinoma

“… / Crizotinib 12 m, alive LTO_13 [ 14 ] 33 No U L:7.9*6.9 Adnexal mass biopsy solid acinar Synchronous, bilateral supraclavicular lymph node Positive / Neg. / Crizotinib 4 m, alive LTO_14 [ 15 ] 41 No U L: 10 Left salpingo-oophorectomy solid acinar 8 m, pleural / Rearrangement Neg. Neg.…”

Lung Adenocarcinoma with Metachronous Ovarian Metastasis: a long survival case report

“…Traditionally, systemic therapy is recommended as the standard therapy for metastatic lung cancer. More remarkably, positive status of driven genes like anaplastic lymphoma kinase (ALK) rearrangement and EGFR mutation in lung cancer with ovarian metastasis has dramatically been reported [7][8][9][10][11] in the latest decade and low toxic targeted therapy would prolong the patients' lives. For the metastatic lung cancer patients, especially who have received multiple-lines treatments, one problem appeared whether it is necessary to perform surgery debulking for accurate diagnosis.…”

Metastasis manners and the underlying mechanisms of ALK and ROS1 rearrangement lung cancer and current possible therapeutic strategies

“…Jing and colleagues presented a case of a 41 year-old woman who was initially diagnosed with NSCLC adenocarcinoma on histology. 52 Aer receiving a 6-course rst-line chemotherapy and 8-course maintenance therapy, emergency surgery was performed and the resected tissues were sent for pathological evaluation and immunohistochemistry (IHC) analysis. The pathological diagnosis of the resected ovarian was metastatic pulmonary adenocarcinoma and a positive indication for ALK rearrangement was found in a metastatic ovarian lesion.…”

“…Aer the detection of ALK rearrangement, crizotinib was administered, and the disease remained stable aer 10 months of crizotinib therapy. 52 Although several cases of ovarian metastasis involving ALK rearrangement have been presented, only one case of bilateral ovarian metastasis from ROS1 translocated lung adenocarcinoma has been reported so far. Franchina et al presented a case of a 43 years old never smoking woman diagnosed with metastatic lung adenocarcinoma.…”