小原发性肺腺癌所致双侧巨大卵巢转移：从困境到诊断

摘要(中文译文)

卵巢转移大多见于妇科和胃肠道恶性肿瘤，其次是乳腺癌。肺癌很少转移至卵巢，反之亦然。仅有极少数关于肺癌卵巢转移的报道。在本例中，一名中年患者以卵巢癌就诊。18-F FDG PET/CT通过检出孤立性肺部病灶，改变了患者的治疗策略。组织病理学和免疫组化在做出准确诊断并据此决定患者长期治疗方案中发挥了关键作用。在本例中，一名52岁女性因腹部包块就诊，病史三个月。查体可触及一个较大的固定腹部肿块。18-F FDG PET/CT显示双侧附件区病变、可疑淋巴结肿大以及一个小的代谢活跃的右肺结节。通过对腹腔镜双侧附件区病变切除标本及胸腔镜肺病灶切除标本进行组织病理学评估，确立了双侧卵巢受累的转移性肺腺癌的明确诊断。18-F FDG PET/CT及细致的临床病理学关联分析使这一罕见的原发性肺腺癌双侧卵巢转移病例得以识别和管理。本病例凸显了代谢显像在复杂肿瘤表现中的重要作用，进一步强调了免疫组化在表征这些病变及指导后续患者管理中的关键作用。

Abstract

Ovarian metastasis has been reported mostly in gynaecological and gastro-intestinal malignancies followed by breast. Lung cancers rarely metastasize to ovaries and vice versa. Only ovarian metastasis from lung is rarely reported. In our case a mid-age patient presented as a case of carcinoma ovary. 18-F FDG PET/CT led to change in management of the patient by detecting solitary lung lesion. Histopathology and IHC played a pivotal role in making an accurate diagnosis and thus deciding the long term management of patient. In our case a 52-year-old woman presented with a three-month history of abdominal lump. On examination a large non-mobile abdominal mass was felt. 18-F FDG PET/CT revealed bilateral adnexal lesions, suspicious lymphadenopathy, and a small metabolically active right lung nodule. Definitive diagnosis of metastatic pulmonary adenocarcinoma involving both ovaries was established after histopathology evaluation of specimens obtained from laparoscopic excision of bilateral adnexal lesions and thoracoscopic excision of lung lesion. 18-F FDG PET/CT and vigilant clinicopathological correlation enabled the identification and management of this rare instance of bilateral ovarian metastases from primary lung adenocarcinoma. This case highlights the essential role of metabolic imaging in complex oncological presentations. It further underscores the pivotal role of immunohistochemistry in characterizing these lesions and guiding subsequent patient management.

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