卵巢转移性肺腺癌5例临床病理分析并文献复习

Ovarian metastatic lung adenocarcinoma:a clinicopathological analysis of five cases with review of literature

目的探讨肺腺癌卵巢转移的临床病理特征及分子遗传学特点。方法收集5例肺腺癌卵巢转移患者的临床资料,行HE、免疫组化EnVision两步法染色,对转移灶行二代测序检测,并复习相关文献。结果5例患者平均年龄55.6岁,3例有肺腺癌病史,分别于肺癌术后45、47、57个月发生卵巢转移;2例以盆腔巨大包块就诊。5例患者均行双侧附件切除,镜下形态以复杂腺体型为主。免疫表型:5例Napsin A、TTF-1、CK7均阳性,ER、PR、PAX8及CK20均阴性。5例患者卵巢转移灶二代测序检测显示:4例EGFR基因突变,1例ALK基因融合。4例卵巢肿瘤术后行化疗及靶向治疗,1例未行靶向治疗。4例获得随访,其中2例分别随访12、62个月仍健在,2例患者均于确诊卵巢转移后13个月死亡。结论卵巢为肺腺癌的罕见转移部位,可呈囊实性或囊性肿块,需与卵巢原发性肿瘤鉴别,联合使用靶向药物可提高患者的生存率。

Purpose To explore the clinicopathological and molecular characteristics of lung adenocarcinoma with ovarian metastasis.Methods A clinicopathological analysis was performed on 5 cases of lung adenocarcinoma with ovarian metastasis.All cases were analyzed by hematoxylin-eosin staining and immunohistochemical staining,and next-generation sequencing.Results The mean age of the patients was 55.6 years.3 cases had a history of lung adenocarcinoma,developed ovarian tumors within 45 months,47 months and 57 months from the initial diagnosis of lung adenocarcinoma,respectively.2 case was present with a huge pelvic mass.All 5 patients underwent bilateral appendage resection.Microscopically,complex glandular patterns were the main morphologies.All three cases were positive for TTF-1,Napsin A and CK7 but negative for ER,PR,PAX8 and CK20.All 5 patients with ovarian metastases underwent NGS molecular detection,showing 4 with EGFR mutation and 1 with ALK-EML4 fusion.All 5 patients received adjuvant chemotherapy after operation,and 4 of them received corresponding molecular targeted therapy.4 cases were followed up:two cases were followed up for 12 and 62 months respectively and were still alive,two died 13 months after the diagnosis of ovarian metastasis.Conclusion Ovary is a rare metastatic site of lung adenocarcinoma.It shows cystic solid or cystic mass,which needs to be differentiated from primary ovarian tumor.The combination of targeted drugs will improve the survival rate of patients.