Giant bilateral ovarian metastases from small primary pulmonary adenocarcinoma: from dilemma to diagnosis

BACKGROUND: Ovarian metastasis has been reported mostly in gynaecological and gastro-intestinal malignancies followed by breast. Lung cancers rarely metastasize to ovaries and vice versa. Only ovarian metastasis from lung is rarely reported. In our case a mid-age patient presented as a case of carcinoma ovary. 18-F FDG PET/CT led to change in management of the patient by detecting solitary lung lesion. Histopathology and IHC played a pivotal role in making an accurate diagnosis and thus deciding the long term management of patient. CASE PRESENTATION: In our case a 52-year-old woman presented with a three-month history of abdominal lump. On examination a large non-mobile abdominal mass was felt. 18-F FDG PET/CT revealed bilateral adnexal lesions, suspicious lymphadenopathy, and a small metabolically active right lung nodule. Definitive diagnosis of metastatic pulmonary adenocarcinoma involving both ovaries was established after histopathology evaluation of specimens obtained from laparoscopic excision of bilateral adnexal lesions and thoracoscopic excision of lung lesion. CONCLUSION: 18-F FDG PET/CT and vigilant clinicopathological correlation enabled the identification and management of this rare instance of bilateral ovarian metastases from primary lung adenocarcinoma. This case highlights the essential role of metabolic imaging in complex oncological presentations. It further underscores the pivotal role of immunohistochemistry in characterizing these lesions and guiding subsequent patient management.