Ovarian Cancer Metastasis to Lung Parenchyma without Peritoneal Dissemination: A Rare Case
Ovarian cancer is the most lethal gynecological malignancy worldwide. Despite the advances in treatment for ovary cancer, the 5-year survival rate of advanced ovarian cancer patients with peritoneal metastasis remains as high as 30%. Clinical stage is the most important prognostic factor and most patients are at an advanced stage. There is often no clearly identifiable precursor lesion; therefore, the events which lead to metastatic disease are poorly understood. Solitary lung parenchyma metastasis is extremely rare. We report a case of 39-year-old woman who was admitted with a lung mass. She had a history of high-grade serous carcinoma ovary, which was detected and treated 6 years ago with cytoreductive surgery as well ashyperthermic intraperitoneal and adjuvant chemotherapy. During the routine follow-up, positron emission tomography computed tomography scan showed two nodules of soft-tissue density in the lung parenchyma of the left lower lobe with a dimension of 2.8 × 2.5 cm. Intraoperatively, two conglomerated lung nodules seen in lung parenchyma of the left lower lobe. Deeper nodule was in close proximity to the left lower lobe bronchus and left lower lobe pulmonary artery. Video-assisted thoracoscopic surgery was conducted to perform left lower lobectomy. Postoperatively, the patient was stable. Microscopically, the tumor was classified as a high-grade serous carcinoma, and the patient was diagnosed for having an ovarian cancer metastasis. Ovarian cancer rarely metastasizes to the lung parenchyma in a relapse. However, excision of lesion with further chemotherapy showed excellent results. Surgical excision biopsy and intraoperative frozen sectioning, followed by lobectomy or segmentectomy, are both diagnostic and therapeutic.
Siegel RL, Miller KD, Fuchs HE, et al., 2022, Cancer Statistics, 2022. CA Cancer J Clin, 72:7–33. DOI: 10.3322/caac.21708
Kurman RJ, Visvanathan K, Roden R, et al., 2008, Early Detection and Treatment of Ovarian Cancer: Shifting from Early Stage to Minimal Volume of Disease Based on a New Model of Carcinogenesis. Am J Obstet Gynecol, 198:351–6. DOI: 10.1016/j.ajog.2008.01.005
Tobacman JK, Greene MH, Tucker MA, et al., 1982, Intra-Abdominal Carcinomatosis after Prophylactic Oophorectomy in Ovarian-Cancer-prone Families. Lancet, 2:795–7. DOI: 10.1016/s0140-6736(82)92681-2
Lee YC, Jeon SY, Park SY, et al., 2015, Late Recurrence of Ovarian Cancer Mimicking a Primary Lung Malignancy after Curative Resection. Soonchunhyang Med Sci, 21:201–4. DOI: 10.15746/sms.15.047
Coffman LG, Burgos-Ojeda D, Wu R, et al., 2016, New Models of Hematogenous Ovarian Cancer Metastasis Demonstrate Preferential Spread to the Ovary and A Requirement for the Ovary for Abdominal Dissemination. Transl Res, 175:92–102.e2. DOI: 10.1016/j.trsl.2016.03.016
Rose PG, 2022, Symptoms of Women with High-risk Early- Stage Ovarian Cancer. Obstet Gynecol, 139:1196. DOI: 10.1097/AOG.0000000000004816
Available from: https://seer.cancer.gov/statfacts/html/ovary. html [Last accessed 2022 Aug 15].
Heintz AP, Odicino F, Maisonneuve P, et al., 2006, Carcinoma of the Ovary. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet, 95:S161–92. DOI: 10.1016/S0020-7292(06)60033-7
Hoskins WJ, 1994, Epithelial Ovarian Carcinoma: Principles of Primary Surgery. Gynecol Oncol, 55:S91–6. DOI: 10.1006/gyno.1994.1346
Lengyel E, 2010, Ovarian Cancer Development and Metastasis. Am J Pathol, 177:1053–64. DOI: 10.2353/ajpath.2010.100105
Available from: https://mets.getthediagnosis.org/met/lung_ parenchyma.htm [Last accessed 2022 Aug 15].
Sørensen JB, 2004, Endobronchial Metastases from Extrapulmonary Solid Tumors. Acta Oncol, 43:73–9. DOI: 10.1080/02841860310018053
Kerr VE, Cadman E, 1985, Pulmonary Metastases in Ovarian Cancer. Analysis of 357 Patients. Cancer, 56:1209–13. DOI: 10.1002/1097-0142(19850901)56:5<1209:aid-cncr2820560542>3.0.co;2-y
Seo JB, Im JG, Goo JM, et al., 2001, Atypical Pulmonary Metastases: Spectrum of Radiologic Findings. Radiographics, 21:403–17. DOI: 10.1148/radiographics.21.2.g01mr17403
Xiang Z, Zhang J, Zhao J, et al., 2020, An Effective Inflation Treatment for Frozen Section Diagnosis of Small-Sized Lesions of the Lung. J Thorac Dis, 12:1488–95. DOI: 10.21037/jtd.2020.02.34
Cormio G, Rossi C, Cazzolla A, et al., 2003, Distant Metastases in Ovarian Carcinoma. Int J Gynecol Cancer, 13:125–9. DOI: 10.1046/j.1525-1438.2003.13054.x
Huang Z, Yan H, Chavan D, et al., 2018, Effective Treatment of a Patient with Stage IV Ovarian Cancer: A Case Report. Oncol Lett, 15:588–91. DOI: 10.3892/ol.2017.72