Title: Carcinoma Lung Presenting As Ovarian Mass – A Case Report
Authors: Dr Sajeed. A, Dr Geethi M H, Dr John Joseph, Dr Susan Mathews, Dr Preethi.T.R
DOI: http://dx.doi.org/10.18535/jmscr/v3i11.48
Abstract
Differentiation of primary versus secondary malignant neoplasms of the ovary presents a diagnostic dilemma particularly when the patient presents initially with a large ovarian mass. The secondary tumors usually arise from digestive system or breast, while a primary in the lung is very rare. We report the case of a 28 year old lady who presented with bilateral adnexal complex mass and a left sided pleural effusion on the preoperative computed tomography scan, subsequently underwent a staging laparotomy with removal of the mass, total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, appendisectomy, pouch of douglas and bladder peritonectomy. Initial pathologic examination of the specimen suggested primary mucinous adenocarcinoma (Cytokeratin 7 (CK7) positive and CK20 negative). No Gastrointestinal (GI) tract primary and pleural fluid was negative for malignant cells. The patient was referred to our centre after initiation of chemotherapy in the line of a primary ovarian malignancy. The pathology review at our centre showed morphology and IHC more in favour of a metastatic lesion from a lung primary. (CK7+, TTF-1+ and Napsin+, CK 20-, CDX2- and PAX 8- ). Repeat CT Chest revealed a lobulated mass left lower lobe and diffuse irregular pleural thickening. Chemotherapy was changed for the primary lung lesion. Our case report focuses on the clinical and pathologic diagnostic challenge of distinguishing secondary from primary ovarian neoplasms as well as locating the site of primary. Need and usefulness of a complete immunohistochemical profile is also stressed upon.
Keywords: secondary ovarian neoplasm, lung primary, immunohistochemistry
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