A Single Lung Metastasis of Endometrioid Adenocarcinoma Synchronous with a Primary Bronchioloalveolar Carcinoma in the Same Lobe

Abstract

A 63-year-old woman was referred for evaluation of a mass in the lower lobe of the right lung. The patient, a nonsmoker, in 1989 underwent a bilateral ovariohysterectomy for synchronous enometrioid adenocarcinoma of the uterus and ovary (stage I uterus, stage IA FIGO ovary). The postoperative follow-up (10 years) was uneventful. Recently, due to a right chest pain, the patient underwent a chest roentgenogram demonstrating a mass of the right lower lobe. A subsequent computed tomography of the chest showed a 40 32 mm pulmonary mass of the right lower lobe (Fig 1) in which was also present a 40 mm pure ground glass opacity (Fig 2). Positron emission tomography showed increased fluorodeoxyglucose uptake in the posterolateral portion of the right lower lobe corresponding to the pulmonary mass; hilar and mediastinal activity was normal. Bronchoscopy, lobar bronchial washing, and brushing were negative. Tumor markers (CA-125, NSE, CYFRA, CEA) were negative. A transthoracic biopsy of the mass suggested a metastatic endometrioid adenocarcinoma. The patient underwent a right thoracotomy, with a biopsy of the consolidation area of the lung corresponding to the pure ground glass opacity. Because an intraoperative frozen section suggested a primary bronchioloalveolar adenocarcinoma, a right lower lobectomy with systematic mediastinal limphadenectomy was performed. Final pathologic evaluation of the specimens revealed a metastatic endometrioid adenocarcinoma (Fig 3A), immunoreactive for estrogen (Fig 3B) and progesterone receptors and negative for TTF-1, corresponding to the mass, and a primary