Ovarian metastasis from pulmonary adenocarcinoma
A 44-year-old non-smoking Korean woman visited the local clinic with chest and back pain. A pulmonary nodule was seen on chest computed tomography (CT), and the patient was diagnosed with an unresectable pulmonary adenocarcinoma after performing bronchoscopy washing and right supraclavicular lymph node biopsy. After being diagnosed, she was transferred to Samsung Medical Center (SMC). At that time, brain, bone and pleural metastases were seen, therefore, the patient was treated with pemetrexed-cisplatin-based chemotherapy. After the forth cycle, the chest CT showed that the nodule had slightly decreased in size. At that point, the patient was planned to undergo the remaining chemotherapy cycles.\nThree weeks later, she felt abrupt low abdominal pain. She then visited the hospital and underwent CT and laboratory testing. The CT revealed no specific findings except for a myoma-like mass in the pelvis. She was then transferred back to SMC. On physical examination, a fetal head size mass was detected in the lower abdomen, and the patient felt mild abdominal pain and tenderness. Tarchycardia and a mild fever were also noted.\nUltrasound revealed, a 12.55 × 8.29 cm diffuse hypoechoic cystic mass with papillary projection in the pelvic cavity. Magnetic resonance imaging (MRI) and CT imaging revealed a 12 × 9.3 cm cystic and solid mass arising from the right adnexa as well as a torsion knob and hemorrhage, suggesting torsion of a cyst on the right ovary (). CA-125 and CA-19-9 values were within the normal ranges.\nThe patient subsequently underwent an exploratory laparotomy, during which a 10 cm right ovarian cyst with significant torsion of >720 degrees. Frozen section of the right ovarian specimen demonstrated malignancy. Bilateral salpingo-oophectomy, total abdominal hysterectomy and partial omentectomy was performed. Gross pathological examination showed 12 ×10 cm of right ovarian tumor and cystic space showing a black hemorrhage and solid portion. Microscopic pathology revealed metastatic adenocarcinoma on the right ovary, no evidence of malignancy was seen in the left ovary, uterus, or omentum ().\nAfter the surgery, a chest CT showed no interval change of the lung, pleura, lymph node size, while brain MRI showed slightly increased multiple brain metastatic lesions. Her lung cancer was followed by an oncologist who changed chemotherapy regimen to crizotinib, the target therapy. With regular follow-up imaging, she has remained on crizotinib until now (27 months), and underwent gamma knife surgery twice as well as 2 cycles of radiotherapy (brain, spine). With crizotinib, her condition and cancer mass are stable, therefore, the oncologist is continuing the target therapy.