A 60-year-old woman presented with cough and dyspnea in March 2012. Computed tomography (CT) scan showed a left lower lobe mass, as well as pleural metastasis and pleural effusion. A pathological diagnosis of adenocarcinoma was performed by pleural biopsy. Lung tumor tissue was wild-type of epidermal growth factor receptor (EGFR) by the method of real-time polymerase chain reaction. Then she received two-line chemotherapies (docetaxel (75 mg/m2) + carboplatin (4 area under the curve) × 6 cycles and pemetrexed (500 mg/m2) + cisplatin (60 mg/m2) × 6 cycles, respectively ) with the best response of stable disease (SD) for each regimen, but it finally failed for progressive disease (PD) with new metastasis in bones and brain. Gefitinib had been administrated as her third-line treatment since July 2014.
In June 2016, she was admitted with the complaint of abdominal discomfort and obvious weight loss. CT scan of the ovarian tumor revealed the admixture of enhanced solid components and cysts, left 4.6 × 3.5 cm, right 2.6 × 2.9 cm, with extensive peritoneal thickening and massive ascites. Then, she underwent tumor debulking surgery. The tumor invaded not only bilateral ovaries but also peritoneum, bladder, uterine. Even a great many of small nodules scattered in the surface of intestinal tubes. The following procedures were done: bilateral salpingooophorectomy, partial omentectomy, and peritoneal washings with cisplatin 80 mg.
Pathology showed a moderately differentiated papillary adenocarcinoma in ovarian. The tumor cells were arranged into glandular tubular and papillary structures with apical snouts and huge, hyperchromatic nuclei (Fig. 1A and 1B). Mucous epithelium could be seen in some areas with stromal fibrous proliferation. Tumor cells were immunopositive for thyroid transcription factor 1(TTF-1), Napsin-A and cytokeratin (CK)-7 (Fig. 2A, 2B and 2C), and negative for paired box 8 (PAX-8), estrogen receptors (ER), progesterone receptor (PR) and CK20. Combined with the initial results of pleural biopsy (Fig. 1C and 1D), the diagnosis of ovarian metastasis from lung adenocarcinoma was established.
Evaluated by the testing method as before, it showed EGFR T790M mutation in exon 20. Then the patient received oral administration of osimertinib. Up to now, the patient has shown no evidence of progression on regular follow-up for 8 years after the initial diagnosis of primary lung cancer and 46 months after her ovarian metastasis.