Carcinoma of Unknown Primary Site (CUP) With Metastatic Renal-Cell Carcinoma (mRCC) Histologic and Immunohistochemical Characteristics (CUP-mRCC): Results From Consecutive Patients Treated With Targeted Therapy and Review of Literature

Øverby, Anders; Duval, Lone; Ladekarl, Morten; Laursen, Britt Elmedal; Donskov, Frede

doi:10.1016/j.clgc.2018.08.005

Cited by 21 publications

(16 citation statements)

References 37 publications

(67 reference statements)

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“…Nonclear cell histologies with a large proportion of unclassified RCCs seem predominant in CUP [15]. After initiating the CUPISCO trial, two publications suggested that approximately 4%–5% of CUPs show morphology and IHC consistent with mRCC in the absence of a kidney lesion [14, 15] The authors claim that patients with CUP‐mRCC should be considered for RCC‐specific therapy. Contrast‐enhanced CT/MRI is the imaging modality of choice in the diagnosis of RCC and has a median sensitivity of 88% [25].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, two publications presented data suggesting that 4%-5% of patients with CUP show IHC profiles consistent with metastatic renal cell carcinoma (mRCC) [14,15] in the absence of renal cancer imaging. We excluded eight (6.5%) patients based on histomorphology, IHC profile (Pax8, Pax2, CD10, Racemase, RCC, CAIX, TFE3, TFEB), and compatibility with RCC in contrast-enhanced CT/MRI imaging.…”

Section: Carcinoma Cases Not Compatible With Cup Because Of Proof or Strong Evidence Of A Likely Primary Tumormentioning

confidence: 99%

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A Challenging Task: Identifying Patients with Cancer of Unknown Primary (CUP) According to ESMO Guidelines: The CUPISCO Trial Experience

et al. 2021

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Background. CUPISCO is an ongoing randomized phase II trial (NCT03498521) comparing molecularly-guided therapy versus platinum-based chemotherapy in patients newly diagnosed with 'unfavorable' cancer of unknown primary (CUP). Patients and Methods. Patients with an unfavorable CUP diagnosis, as defined by the European Society of Medical Oncology (ESMO), and available cancer tissue for molecular sequencing are generally eligible. Potential CUP patients entering screening undergo a review involving reference histopathology and clinical work-up by a central Eligibility Review team (ERT). Patients with "favorable" CUP, a strongly suspected primary site of origin, lack of tissue, or unmet inclusion criteria are excluded. Results. As of April 30, 2020, 628 patients had entered screening and 346 (55.1%) were screen failed. Screen fails were due to technical reasons (N=89), failure to meet inclusion/exclusion criteria not directly related to CUP diagnosis (N=89) and other reasons (N=33). 124 (35.8%) patients were excluded because unfavorable adeno-or poorly differentiated CUP could not be confirmed by the ERT. These cases were classified into 3 groups ineligible due to (i) histologic subtype, such as squamous and neuroendocrine, or favorable CUP; (ii) evidence of a possible primary tumor or (iii) non-carcinoma histology. Conclusions. Experience with CUPISCO has highlighted challenges with standardized screening in an international clinical trial and the difficulties in diagnosing unfavorable CUP. Re-confirmation of unfavorable CUP by an ERT in a clinical trial can result in many reasons for screen failures. By sharing this experience, we aim to foster understanding of diagnostic challenges and improve diagnostic pathology and clinical CUP algorithms. Implications for Practice:: A high unmet need exists for improved treatment of cancer of unknown primary (CUP); however, study in a trial setting is faced with the significant challenge of definitively distinguishing CUP from other cancer types. Here we report on our experience of this challenge so far in the ongoing CUPISCO trial, which compares treatments guided by patients' unique genetic signatures versus standard chemotherapy. The data presented will aid future decision-making regarding diagnosing true CUP cases; this will have far-reaching implications in the design, execution and interpretation of

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Section: Discussionmentioning

confidence: 99%

Section: Carcinoma Cases Not Compatible With Cup Because Of Proof or Strong Evidence Of A Likely Primary Tumormentioning

confidence: 99%

A Challenging Task: Identifying Patients with Cancer of Unknown Primary (CUP) According to ESMO Guidelines: The CUPISCO Trial Experience

et al. 2021

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“…For patients without an identifiable kidney primary, obtaining tissue from the metastatic site is critical for diagnosis. Prognosis is heterogenous, with one series of 10 patients demonstrating a median survival of 5.7 months with targeted systemic regimens 5 . Other case reports suggest a robust progression-free response after excision of metastatic lesions.…”

Section: Discussionmentioning

confidence: 99%

Metastatic clear cell renal cell carcinoma to the forearm without identifiable primary renal mass

Walton

Clifton

et al. 2019

Urology Case Reports

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Kidney cancer is the ninth most common malignancy in the United States. Most kidney cancers are clear cell renal cell carcinoma (RCC) and arise as solid tumors from kidney parenchyma. In the setting of metastatic disease, a primary renal tumor is usually identified, and metastases are often to lung, bone, liver, and brain. Metastatic RCC without an identifiable solid kidney tumor is exceedingly rare. We report the case of a 52 year old male with a rare cutaneous RCC metastasis without an identifiable primary renal tumor.

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“…Усилия практических врачей при наличии отдаленных метастазов без выявленного первичного очага должны быть направлены на поиски первичной опухоли. При этом морфологическое подтверждение органопринадлежности метастатической опухоли осуществляется гистологически и обязательно иммуногистохимически, а в последние годы и профилирование экспрессии генов, особенно в сомнительных случаях, позволяющих уточнить тканевую принадлежность опухоли [9,10,[25][26][27]. Это позволит проводить целе-направленное, персонализированное лечение вместо эмпирических схем химиотерапии, что, безусловно, улучшает прогноз течения заболевания [4,26,27].…”

Section: рис 3 пациент у 52 года аксиальная пэт/кт-(а) и кт-проеunclassified

“…Учитывая высокую чувствительность ПКР к таргетной терапии, пациентам назначают ингибиторы тирозинкиназы и эндотелиального фактора роста с хорошим клиническим эффектом в виде длительного контроля течения заболевания [11,26].…”

Section: рис 3 пациент у 52 года аксиальная пэт/кт-(а) и кт-проеunclassified

Metastatic renal cell carcinoma of unknown primary site. Clinical follow-up

Огнерубов

Antipova²,

Гумарева

2020

J. Mod. Onco.

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Renal cell cancer metastases without evidence of a primary tumor are extremely rare. These variants are usually showed as a spontaneous description of single clinical cases. Aim.This contribution is a clinical follow-up of synchronous renal cell cancer metastases of unknown primary site. Results.A 52-year-old patient U. with a history of increased blood pressure, up to 170/100 mmHg for the last 5 years, who had undergone many instrumental examinations, including ultrasound examination, because of this disease. The computed tomography of the abdomen showed a 4975 mm heterogeneous tumor in the right adrenal gland in October 2017. The combined positron emission and X-ray computed tomography showed a 795441 mm mass in the right adrenal gland, associated with elevated fluorodeoxyglucose metabolic activity SUVmax 7.25. Focal accumulation of the radiopharmaceutical SUVmax 4.31 in a 171124 mm mass was detected in the space of bifurcation in the mediastinum. The lytic lesion (1015 mm) was found in right superior L3 articular process. The patient underwent retroperitoneoscopic adrenalectomy and thoracoscopic removal of mediastinal tumor in November 2017 because of the oligometastatic nature of the process. The histological study identified clear-cell carcinoma with areas of papillary structure in the right adrenal gland. The immunohistochemical study showed carcinoma cells intensively expressing CD10, and some other cells RCC. The immune phenotype of the tumor was identified as clear-cell renal cell carcinoma. The immunohistological and immunohistochemical analysis reviled the metastases of the same variant of renal cell carcinoma in one of 9 lymph nodes. The patient was treated with pazopanib. The primary renal tumor was not detected during the dynamic observation, including the application of annual combined positron emission and X-ray computed tomography. The patient is alive without disease progression with a follow-up of 32 months. Conclusion.Metastases of clear-cell renal cell carcinoma, including adrenal gland, without evidence of a primary site are extremely rare. The main method of treatment is a combination of surgery and targeted therapy, providing long-term local control of the course of the disease.

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Carcinoma of Unknown Primary Site (CUP) With Metastatic Renal-Cell Carcinoma (mRCC) Histologic and Immunohistochemical Characteristics (CUP-mRCC): Results From Consecutive Patients Treated With Targeted Therapy and Review of Literature

Cited by 21 publications

References 37 publications

A Challenging Task: Identifying Patients with Cancer of Unknown Primary (CUP) According to ESMO Guidelines: The CUPISCO Trial Experience

A Challenging Task: Identifying Patients with Cancer of Unknown Primary (CUP) According to ESMO Guidelines: The CUPISCO Trial Experience

Metastatic clear cell renal cell carcinoma to the forearm without identifiable primary renal mass

Metastatic renal cell carcinoma of unknown primary site. Clinical follow-up

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