Ovarian metastatic lung adenocarcinoma： a retrospective clinicopathological analysis of a consecutive 10-year case series

Abstract Background Ovarian metastatic lung adenocarcinoma is rarely detected in clinical practice, and only a few cases have been reported. Its clinicopathological features, molecular genetics, and prognosis have not been well characterized. Results Seventeen patients diagnosed with ovarian metastatic lung adenocarcinoma between 2013 and 2022 were analyzed retrospectively. All patients were non-smokers, with a median age of 46 years (range, 30 to 71y). Unilateral ovarian involvement was more frequent than bilateral involvement (58.8% vs 41.2%). Lesions presented as solid ovarian or mixed cystic and solid masses, and nearly two-thirds of the tumors (64.7%) had a diameter greater than 10 cm. More than one-third of the patients (41.2%) initially presented with pelvic masses with abdominal distension and/or lower abdominal pain, 100% of patients had elevated CA125 levels, and 76.5% had ascites. Most patients (76.5%) harbored driver gene alterations, including eight cases with EML4-AL K gene fusion and five cases with EGFR mutation. ALK rearrangement tumors showed solid adenocarcinomas (6/8,75.0%) and mucinous adenocarcinomas (2/8, 25.0%); however, acinar adenocarcinoma (6/9, 66.7%) was the most common type in non- ALK rearrangement cases. The 3-year overall survival (OS) of patients with ALK rearrangement and non-ALK rearrangement was 80.0% and 30.0%, respectively (p < 0.05). Conclusion Ovarian metastatic lung adenocarcinoma exhibits distinctive clinicopathological features and can mimic primary ovarian carcinoma. ALK rearrangement is the most common molecular alteration, and these patients have a better prognosis than those with non- ALK rearrangement. Genetic testing is recommended in all patients with ovarian metastatic lung adenocarcinoma to provide them with an opportunity to undergo targeted therapy.