Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2019; 7(12): 1515-1521
Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1515
Female genital tract metastasis of lung adenocarcinoma with EGFR mutations: Report of two cases
Run-Lan Yan, Jie Wang, Jian-Ya Zhou, Zhen Chen, Jian-Ying Zhou
Run-Lan Yan, Jie Wang, Jian-Ya Zhou, Jian-Ying Zhou, Department of Respiratory Diseases, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Zhen Chen, Department of Pathology, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Zhou JY and Zhou JY designed the report; Wang J and Chen Z collected the patient’s clinical data; Yan RL analyzed the data and wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81670017.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images and is available upon request.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian-Ying Zhou, MD, Chief Doctor, Professor, Department of Respiratory Diseases, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. zjyhz@zju.edu.cn
Telephone: +86-571-87236876 Fax: +86-571-87236877
Received: January 29, 2019
Peer-review started: January 29, 2019
First decision: March 9, 2019
Revised: March 24, 2019
Accepted: April 18, 2019
Article in press: April 19, 2019
Published online: June 26, 2019
Abstract
BACKGROUND

The female genital tract is an uncommon site of involvement for extra-genital malignancies. Ovarian metastases have been described as disseminations of lung adenocarcinoma; rare cases of secondary localizations in the cervix, adnexa, and vagina have also been reported in the literature. Here, we report two cases of advanced lung adenocarcinoma with female genital tract metastasis.

CASE SUMMARY

The first case was a 41-year-old woman with stage IV lung adenocarcinoma metastasizing to the cervix. Immunohistochemistry of the cervical biopsy specimen revealed thyroid transcription factor (TTF)-1(+), cytokeratin (CK)-7(+), and (CK)-20(-). Gene mutational analysis showed epidermal growth factor receptor (EGFR) L858R mutation in exon 21. She had a positive response to gefitinib, for both the pulmonary mass and cervical neoplasm. The second case was a 29-year-old woman who was diagnosed with stage IV lung adenocarcinoma with EGFR mutation. After 12 mo of treatment with icotinib, ovarian biopsy showed adenocarcinoma with CDX2(-), TTF-1(+++), PAX8(-), CK-7(+++), CK-20(++), and Ki67(15%+), accompanied with EGFR 19-del mutation and T790M mutation.

CONCLUSION

Immunohistochemistry and gene mutational testing have greatly helped in locating the initial tumor site when both pulmonary and female genital tract neoplasms exist.

Keywords: Lung adenocarcinoma, Epidermal growth factor receptor, Metastasis, Ovary, Cervix, Case report

Core tip: The female genital tract is an uncommon site of involvement for extra-genital malignancies. Ovarian metastases have been described as disseminations of lung adenocarcinoma; rare cases of secondary localizations in the cervix, adnexa, and vagina have also been reported in the literature. Here, we report two cases of advanced lung adenocarcinoma with female genital tract metastasis. The initial tumor site should be considered when both pulmonary and female genital tract neoplasms exist. Immunohistochemistry and gene mutational testing have greatly helped in locating the initial tumor site.