An Unusual Association of Lung and Ovarian Malignancy in a Young Nonsmoker Female

An Unusual Association of Lung and Ovarian Malignancy in a Young Nonsmoker Female

Sujoy Dasgupta (Medical College Kolkata, India)
Copyright: © 2012 |Pages: 9
DOI: 10.4018/ijudh.2012100104
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Abstract

Lung cancer in a 25-year-old nonsmoker female is extremely rare. Ovarian malignancy in this age group is also infrequent and if occurs, is usually of germ cell type. If a patient presents with both lung and ovarian mass, the initial impression is the metastasis from one organ to the other. Chest X-ray, ultrasonogram, whole abdomen, CT scan of thorax and abdomen, bronchoscopic biopsy of lung mass and excision biopsy of ovarian mass are all needed to accurately diagnose condition. Therapy is also challenging for such patients. After accurate diagnosis for both the organs, surgery, chemotherapy, or radiotherapy should be considered after individualization of the case. Squamous cell carcinoma lung in advanced stage associated with early stage ovarian serous cystadenocarcinoma has not been described in literature. The rarity of the case, absence of cigarette smoking or radiation exposure, negative family history, unusual association and fatality of the cases prompted us to report this case.
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Case Details

A 25 year old unmarried lady was admitted to our department with complaints of abdominal swelling for one month, anorexia, occasional pain abdomen & vomiting. She had chest pain and haemoptysis 9 months back. Chest X-ray done at that time showed homogeneous opacity in lower zone of the left lung and CT scan showed irregular mass in left lower zone, right lung field normal and few mediastinal lymph nodes (Figure 1 and Figure 2).

Figure 1.

Chest X-ray of the patient at initial presentation showing left sided homogeneous opacity in the lower zone with collapse of the lung

Figure 2.

Histopathological slide of lung tumour showing moderately differentiated squamous cell carcinoma of bronchus

At this point of time author SD posted the case in a web based discussion forum and following is the conversation he had:

Pleural aspirate revealed malignant cells. The patient then underwent bronchoscopy and a polypoidal structure is seen in Left lower bronchus, from which biopsy was taken and the histopathology revealed moderately differentiated infiltrating squamous cell carcinoma bronchus. It is to be noted that she was a nonsmoker and there was no family history of smoking or lung cancer. CT scan of brain and abdomen done at that time showed no evidence of metastasis. One month later, patient underwent left sided thoracotomy which revealed 10 cm x 8 cm x 5 cm growth in left lower lobe, a large (6 cm x 7 cm) hilar lymph node and another large hard lymph node (8 cm x 8 cm) over the aorta. Further procedure was abandoned, declaring it as inoperable carcinoma left lung. Biopsy taken from the growth and lymph nodes also confirmed squamous cell carcinoma. Unfortunately the patient then did not follow medical advice and for next 6 months she consulted alternate medicine specialists and as per her version, she was symptomatically better at that time (Figure 3 and Figure 4).

Figure 3.

CT scan of thorax before chemotherapy showing left sided tumour, right sided pulmonary nodule, pleural effusion, mediastinal lymph nodes

Figure 4.

USG abdomen before laparotomy showing cystic SOL, probably left ovarian mass

After 6 months, suddenly she developed acute onset respiratory distress with chest pain for which she consulted department of Medicine from where she was referred to department of Radiotherapy. After initial stabilization and supportive measures including blood transfusion and pleural fluid drainage, further investigations were done. The CT scan of thorax showed irregular mass with collapse of left lower zone, a pulmonary nodule (8 mm x 10 mm) in right lung and extensive medistinal lymph nodes with bilateral pleural effusion. The radiotherapists initially questioned the diagnosis of squamous cell carcinoma lung due to its rare occurrence in young female non-smoker and they suspected it as lymphoma. But review of previous biopsy slides revealed squamous cell carcinoma. As the patient’s general condition improved, chemotherapy was planned for primary lung carcinoma. After basic investigations, she received one cycle of carboplatin (450 mg) & paclitaxel (260 mg) therapy.

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