Adenocarcinoma of the Lung Metastatic to the Ovary With a Signet Ring Cell Component

Abstract

A nonsmoker 45-year-old woman, presented with a solid right ovarian mass. Microscopic examination revealed heterogeneous histology with tubular formations and extensive signet ring cell component that resembled the usual appearance of metastatic gastric carcinoma to the ovary. Moreover, the histology also showed solid nests of cells with a microvacuolated basophilic cytoplasm similar to those found in adenosquamous cervical carcinoma of glassy cell type. However, analysis of the patient's past history revealed a lung adenocarcinoma, diagnosed 4 years before, which prompted an immunohistochemical differential diagnosis, showing a strong expression for TTF-1 and Napsin A. A cervical primary was excluded taking into account both macroscopic findings and the negative expression of PAX8 and absence of human papillomavirus-related marker p16. This confirmed the pulmonary origin of ovarian tumor despite its heterogeneous morphology. This is the first reported case of ovarian metastatic lung adenocarcinoma, with a signet ring cell component and solid nests, mimicking both metastatic gastric carcinoma and adenosquamous carcinoma of glassy cell type.

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

“… Neg. Crizotinib 10 m, alive LTO_15 [ 16 ] 45 No U R:11 TAH-BSO Solid Solid nests with abundant granular and extensive signet ring cell change 48 m, no concurrent sites / / Mutation in lung cancer / / 1 m, DOD LTO_16 [ 17 ] 37 No U L: 9*5.8 No resection Mixed solid and cysts Acinar and several signet-ring cells Synchronous, brain Pos. in lung cancer Rearrangment in lung cancer / / Alectinib 20 m, alive Abbreviation: TAH-BSO total abdominal hysterectomy and bilateral salpingo-oophorectomy, m month, N/A not applicable, U unilateral, B bilateral, DOD dead of disease, L left, R Right …”

“…Rare casesof adenosquamous carcinoma and mucoepidermoid carcinoma has been reported [ 35 ]. Although there is one reported case of ovarian metastatic lung adenocarcinoma with comprehensive solid and signet ring cells [ 16 ], regrettably, there was no further genetic analysis of this case. Our results also indicated that the solid phenotype is highly suggestive of ALK alteration, and 4/5 cases with solid features harbored ALK rearrangement.…”

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

“…Although metastases of lung adenocarcinoma may appear in any organ, they are more frequently observed in the bone, liver, adrenal gland, brain, and skin and seldom seen in the female genital tract, as metastasis in the female genital tract usually corresponds to small cell carcinomas[3,4]. We review the relevant studies both at home and abroad in recent years corresponding to patients with lung cancer metastasis to the female genital tract; ovarian metastases have been described in several articles[1-3,5-8], while rare cases have been reported for cervical metastasis.…”

Signet Ring Cell Carcinoma of the Lung: A Diagnostic Pitfall in Pregnancy

“…SRCC had similarity in clinicopathologic characteristics with EML4-ALK positive NSCLC [36]. Additionally, several reports on primary SRCC of the lung should be mentioned [9, 34, 37–41].…”