Objective: To report the extremely rare case of ovarian tumour metastasized from Pulmonary Blastoma.

Case Report: Miss YCL, 22 years old, single, Chinese lady, was referred to Respiratory unit of University Malaya Medical Centre (UMMC) in March 2017 for further management of large lobulated right pleural effusion. She presented with right sided chest pain, chronic cough for 3 months associated with hemoptysis for 3 weeks. CT thorax showed a well circumscribed mass at right lower lobe. CT guided biopsy showed features suggestive of pulmonary blastoma. PET scan for staging on 19^th April 2017 reported a mass at right lower lobe with no lymphadenopathy, no skeletal, liver, pancreas and spleen metastasis. The uterus was normal and no mass noted in pelvis. She underwent right lobectomy on 27^th April 2017. HPE showed biphasic pulmonary blastoma with clear margins. She was planned for chemotherapy.

However, just two weeks after lobectomy, she presented to UMMC with abdominal distension, suprapubic pain and vomiting for one week. The pelvic mass was palpable about 16 weeks size. Urine pregnancy test was negative. Tumour markers were normal. CT scan showed a complex, heterogeneous pelvic mass 9.0×9.2×8.5 cm compressing the uterus and bladder. The sigmoid colon was displaced to the right. Right lung showed post resection with residual tumour, right pleural effusion and right pleural base nodule.  In Gynae ward, she experienced shoulder tip pain with lowering her haemoglobin level. She underwent midline laparotomy on 18^th May 2017. Intraoperatively, haemorrhagic left ovarian tumour measuring 8×10 cm and haemoperitoneum about 500 mls was found. Tumour adhered to POD and omentum adhered to the mass. Uterus, right ovary and both tubes were appeared normal. Left salpingo-oophorectomy, omentectomy, right ovarian biopsy and left pelvic lymph node dissection were performed. Histology reported as metastatic pulmonary blastoma of left ovary and omentum. Biopsy from right ovary and left pelvic lymph node showed no malignancy. She was referred back to primary team for further management.

Discussion: Pulmonary blastoma is a rare and very aggressive lung cancer. It is the extremely rare case of ovarian tumour metastasized from Pulmonary blastoma. To our knowledge, this is the second report of ovarian metastasis from Pulmonary blastoma after Lin Yu et al from China in 2009. Ovarian metastasis developed in this patient and made her symptomatic even in less than one month of negative pelvic disease in PET scan. The careful histopathological evaluation gave great value in differentiation of primary ovarian tumour from metastatic tumour in successful further management according to the primary disease.