Female genital tract metastasis of lung adenocarcinoma with EGFR mutations: Report of two cases

Abstract

Background: The female genital tract is an uncommon site of involvement for extra-genital malignancies. Ovarian metastases have been described as disseminations of lung adenocarcinoma; rare cases of secondary localizations in the cervix, adnexa, and vagina have also been reported in the literature. Here, we report two cases of advanced lung adenocarcinoma with female genital tract metastasis.

Case summary: The first case was a 41-year-old woman with stage IV lung adenocarcinoma metastasizing to the cervix. Immunohistochemistry of the cervical biopsy specimen revealed thyroid transcription factor (TTF)-1(+), cytokeratin (CK)-7(+), and (CK)-20(-). Gene mutational analysis showed epidermal growth factor receptor (EGFR) L858R mutation in exon 21. She had a positive response to gefitinib, for both the pulmonary mass and cervical neoplasm. The second case was a 29-year-old woman who was diagnosed with stage IV lung adenocarcinoma with EGFR mutation. After 12 mo of treatment with icotinib, ovarian biopsy showed adenocarcinoma with CDX2(-), TTF-1(+++), PAX8(-), CK-7(+++), CK-20(++), and Ki67(15%+), accompanied with EGFR 19-del mutation and T790M mutation.

Conclusion: Immunohistochemistry and gene mutational testing have greatly helped in locating the initial tumor site when both pulmonary and female genital tract neoplasms exist.

Keywords: Case report; Cervix; Epidermal growth factor receptor; Lung adenocarcinoma; Metastasis; Ovary.

Figure 1

Case 1. A: Positron emission tomography-computed tomography (PET-CT) was performed before lung biopsy and showed hyper-metabolic activity in pulmonary lesions and the cervix uteri; B: PET-CT image showed hyper-metabolic activity in the inferior lobe of the right lung, where lung biopsy was performed; C: CT showed a right pulmonary mass characterized by a solid region with contiguous ground-glass areas, stellate borders, and pleural puckering before tyrosine kinase inhibitor treatment; D: CT showed a right pulmonary mass after 2 mo of gefitinib therapy, which indicated partial remission of tumor; E: CT image showed a right pulmonary mass after 4 mo of gefitinib therapy; F: Magnetic resonance imaging performed on April 12, 201 indicated brain metastasis.

Figure 2

Case 1. A: Cervical biopsy showed poorly differentiated adenocarcinoma; B: Pathological examination of specimens obtained from lung biopsy showed adenocarcinoma with necrosis, and immunohistochemical staining for thyroid transcription factor-1 was positive.

Figure 3

Case 2. A: Computed tomography (CT) scan showed lung lesions with cavity, as well as pleural effusion before tyrosine kinase inhibitor treatment; B: CT showed a right pulmonary mass after 3 mo of ecotinib therapy, which resulted in a partial response after 3 mo; C: CT scan showed pleural effusion after 1 mo of bevacizumab (Avastin) and icotinib therapy; D: CT scan showed pleural effusion after 4 mo of bevacizumab (Avastin) and icotinib therapy, without progression of initial tumor.

Figure 4

Case 2. A: Pathological examination of specimens obtained from lung biopsy showed adenocarcinoma, and immunohistochemical staining for thyroid transcription factor-1 (TTF-1) was positive; B: Ovarian biopsy revealed TTF-1 positive adenocarcinoma.