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Savasta F, Giana M, Libretti A, Genestroni S, Surico D, Remorgida V. Vaginal metastasis of lung cancer: A case report. Case Rep Womens Health 2023; 39:e00536. [PMID: 37663888 PMCID: PMC10468352 DOI: 10.1016/j.crwh.2023.e00536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Lung adenosquamous carcinoma (ASC) is a rare biphasic malignant tumor with squamous cell carcinoma (SCC) and adenocarcinoma (AC) components. ASC is reported to be aggressive; the most common metastatic sites are the regional lymph nodes and surrounding areas. A 46-year-old woman was referred to the emergency department with a persistent dry cough. She underwent fibro-bronchoscopy and was diagnosed with an adenosquamous lung carcinoma. Other than pulmonary and lymphatic findings, a total-body computed tomography (CT) examination highlighted a hypodense formation, of about 9 mm, with a cystic appearance, at the level of the vaginal region. A biopsy performed in the posterior vaginal wall highlighted a vaginal wall flap with subepithelial localization of neoplasia, compatible with the pulmonary ASC. Oncologists took charge of the case and the patient commenced medical therapy with entrectinib. Four months later, she developed dyspnea, and high-resolution CT highlighted an increase in the pathological tissue causing bronchial occlusion. The patient underwent endobronchial stent placement and thereafter restarted therapy with entrectinib, previously stopped because of the new symptoms, and was closely monitored. Apparently only one case of vaginal metastasis from pulmonary tumor has been previously reported, and this is the first report of vaginal metastasis from ASC. Although extremely rare, the presence of such metastasis should be considered in women with suspected vaginal neoformations.
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Affiliation(s)
- Federica Savasta
- Department of Gynaecology and Obstetrics, University of Piemonte Orientale, Ospedale Maggiore della Carità, corso Mazzini 19, Novara, Italy
| | - Michele Giana
- Department of Gynaecology and Obstetrics, University of Piemonte Orientale, Ospedale Maggiore della Carità, corso Mazzini 19, Novara, Italy
| | - Alessandro Libretti
- Department of Gynaecology and Obstetrics, University of Piemonte Orientale, Ospedale Maggiore della Carità, corso Mazzini 19, Novara, Italy
| | - Silvia Genestroni
- Department of Oncology, University of Piemonte Orientale, Ospedale Maggiore della Carità, corso Mazzini 19, Novara, Italy
| | - Daniela Surico
- Department of Gynaecology and Obstetrics, University of Piemonte Orientale, Ospedale Maggiore della Carità, corso Mazzini 19, Novara, Italy
| | - Valentino Remorgida
- Department of Gynaecology and Obstetrics, University of Piemonte Orientale, Ospedale Maggiore della Carità, corso Mazzini 19, Novara, Italy
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Giannella L, Di Giuseppe J, Delli Carpini G, Grelloni C, Fichera M, Sartini G, Caimmi S, Natalini L, Ciavattini A. HPV-Negative Adenocarcinomas of the Uterine Cervix: From Molecular Characterization to Clinical Implications. Int J Mol Sci 2022; 23:ijms232315022. [PMID: 36499345 PMCID: PMC9735497 DOI: 10.3390/ijms232315022] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Cervical cancer is the fourth most common cancer in women. It is the leading cause of female deaths in developing countries. Most of these cervical neoplasms are represented by squamous lesions. Cervical adenocarcinoma causes about a quarter of cervical cancers. In contrast to squamous lesions, cervical glandular disease is HPV-negative in about 15-20% of cases. HPV-negative cervical adenocarcinomas typically present in advanced stages at clinical evaluation, resulting in a poorer prognosis. The overall and disease-free survival of glandular lesions is lower than that of squamous lesions. Treatment options require definitive treatments, as fertility-sparing is not recommended. Moreover, the impact of HPV vaccination and primary HPV screening is likely to affect these lesions less; hence, the interest in this challenging topic for clinical practice. An updated review focusing on clinical and molecular characterization, prognostic factors, and therapeutic options may be helpful for properly managing such cervical lesions.
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Kwon SK, Yu CS, Lee SW, Kim J, Song I, Lee JL, Kim CW, Yoon YS, Park IJ, Lim SB, Kim JC. Isolated vaginal metastasis from stage I colon cancer: A case report. World J Clin Cases 2020; 8:527-534. [PMID: 32110662 PMCID: PMC7031836 DOI: 10.12998/wjcc.v8.i3.527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Distant metastasis occasionally occurs in patients who have been diagnosed with colorectal cancer (CRC), but it occurs in a few patients with stage I CRC. The vagina as a metastasis site has also been reported, albeit rarely. Most reported cases of vaginal metastasis (VM) report their origin from advanced CRC. We encountered a patient who was diagnosed with isolated VM originating from stage I colon cancer (T2N0) and herein present the case of this patient.
CASE SUMMARY A 63-year-old woman visited the outpatient clinic because of a positive result from a stool occult blood test. She underwent laparoscopic anterior resection and was pathologically diagnosed with stage I (T2N0) sigmoid colon cancer. Neither lymphovascular invasion nor perineural invasion was observed. Ten months following the surgery, isolated vaginal metastases were detected on gynecologic examination. The examination was performed due to vaginal spotting. A transvaginal wide excision was performed, and no other adjuvant treatment was provided after discussion with a multidisciplinary team and the patient. Subsequently, a new VM was discovered after 33 mo. An additional transvaginal excision was performed. To date, there has been no evidence of further disease progression. From the time of diagnosis of VM, the patient’s overall survival has been 54 mo.
CONCLUSION VM can occur as a result of early-stage colorectal cancer. Surgeons should consider the possibility of VM following complaints of gynecologic symptoms following surgery.
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Affiliation(s)
- Soon Keun Kwon
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Jihun Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Inho Song
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Jin Cheon Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
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Yan RL, Wang J, Zhou JY, Chen Z, Zhou JY. Female genital tract metastasis of lung adenocarcinoma with EGFR mutations: Report of two cases. World J Clin Cases 2019; 7:1515-1521. [PMID: 31363481 PMCID: PMC6656676 DOI: 10.12998/wjcc.v7.i12.1515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/24/2019] [Accepted: 04/19/2019] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Run-Lan Yan
- Department of Respiratory Diseases, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jie Wang
- Department of Respiratory Diseases, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jian-Ya 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
| | - Jian-Ying Zhou
- Department of Respiratory Diseases, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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