Unknown primary

Chorost, Mitchell I.; Lee, M. Catherine; Yeoh, Cindy; Molina, Mario García; Ghosh, Bimal C.

doi:10.1002/jso.20099

Cited by 44 publications

(38 citation statements)

References 68 publications

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“…Prognosis in patients with cancer of an unknown primary tumor is generally poor, with a median survival time ranging between 4 and 11 months; however, patient care and survival rates are dependent on the knowledge of the primary tumor and localized or disseminated disease [5] The identification of the primary tumor may offer the possibility of a more specific and effective treatment with an improvement of survival time [6]. The key role of whole body FDG-PET scan in this field has been showed by previous studies, and these data led the German Consensus Conference to recognize, in 2001, the whole body FDG-PET study as a standard diagnostic technique, i.e.…”

Section: Discussionmentioning

confidence: 99%

The Role of 18 FDG PET-CT in Evaluation of Unknown Primary Tumours

Saidha

Ganguly

Singh

et al. 2013

Indian J Surg Oncol

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An unknown primary tumor (UPT) is defined as a biopsy-proven malignancy whose anatomic origin remains unidentified after diagnostic evaluation. The estimated incidence of unknown primary tumors is 2 %-7 % of all malignancies. In 15-25 % of cases, the primary site cannot be identified even on postmortem examination. The management of these patients remains a clinical challenge. The aim of this study was to determine the role of 18FDG-PET CT in evaluation of primary tumor and its influence on therapeutic management. Fifty patients with histologically-proven metastases of UPT were included. For all patients, the conventional diagnostic work-up was unsuccessful in localizing the primary site. Whole-body PET/CT images were obtained approximately 60 min after intravenous injection of 350-425 MBq of (18) F-FDG. PET/(CT) depicted histologically verified primary tumors in 21of 46 patients (P>.05), achieving detection rates of approx. 61 % in patients presenting with cervical lymph node metastases from unknown primary tumors, and 40 % in those with extra cervical disease presentation. A positive predictive value of 72 % to 92 % was seen for all patients, depending on category of clinical presentation. In this study, PET/CT detection of additional metastases in 14.2 % (3 cases out of 21 true positives) influenced change in management plan. Considering recent studies and the results of this study, whole body FDG-PET/CT has to be considered a useful tool in evaluating metastases from an UPT, allowing an identification of primary tumors in 42 %, and modifying the stage of the disease and oncological treatment in about 50 % of cases. These results suggest the use of PET/CT with FDG in an early phase of the diagnostic evaluation to optimize the management of these patients.

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Section: Discussionmentioning

confidence: 99%

The Role of 18 FDG PET-CT in Evaluation of Unknown Primary Tumours

Saidha

Ganguly

Singh

et al. 2013

Indian J Surg Oncol

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“…19 The common sites of involvement are the liver, lungs, bones, and lymph nodes. 16,20 Although certain patterns of metastases suggest possible primaries, occult primaries can metastasize to any site. Therefore, one should not rely on patterns of metastases to determine the primary site.…”

Section: 12mentioning

confidence: 99%

Occult Primary

Ettinger¹,

Agulnik²,

Cates³

et al. 2011

J Natl Compr Canc Netw

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“…These clinical presentations could be easily ignored by both clinicians and patients themselves, as it was in this reported case. Thus, Chorost et al, suggested that a complete history should be taken and that a physical examination should be performed for making a correct diagnosis, with special attention to the breast, rectal and pelvic regions [6].…”

Section: Introductionmentioning

confidence: 99%

Osteosarcoma of the Jaws: Case Report on Synchronous Multicentric Osteosarcomas

Jia

2014

JCDR

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A 61-year-old female who had bilateral cystic lesions in her mandible was diagnosed ten months ago, at a local hospital. She complained that she had felt no pain or numbness in her teeth and mandible. Also, she claimed that she had suffered from no tumours or systemic diseases before. Afterwards, a panoramic X-ray was taken, which revealed some radiolucent lesions that were located bilaterally in her posterior mandible. The result showed that the cystic expansion was surrounded by well-defined cortical margins Each cystic lesion contained an un-erupted mandibular third molar. There was no evidence of root-restoration in the adjacent molar teeth .According to the first panoramic X-ray examination, the presumptive result of clinical diagnosis was a dentigerous cyst. Then, the patient was initially treated with bilateral curettage in the local hospital. Meanwhile, an incisional biopsy was taken during the first surgery. The histology of the first biopsy showed a piece of cyst-like tissue, which was lined by non-keratinizing, squamous epithelium [Table/ Fig-1b]. But the stromal necrosis was apparent. The histologic diagnosis of the first biopsy was a cystic lesion which was lined by non-keratinizing, squamous epithelium.Two months after the curettage, the patient was referred to Peking University School and Hospital of Stomatology, after she complained of a mass on the right inferior gingiva that bled painlessly. Another panoramic X-ray was taken, which demonstrated a well-healed left lesion while the right lesion had become a mixed, radiolucentradio opaque mass with a diffuse and irregular borderline [Table/ Fig-2]. Therefore, a second incisional biopsy was performed. The second biopsy specimen was a piece of bone-like hard tissue. Histopathology showed many atypical cells which were embedded in poorly calcified region and the nuclear fission had increased. This time, a histologic diagnosis of a low-differentiated sarcoma was made preoperatively. In order to investigate the original site of the sarcoma, further Positron Emission Computed Tomography (PET/ CT) and Emission Computed Tomography (ECT) were performed. PET/CT demonstrated an enhancing red mass, both in the right mandible and in the left pelvis. The left pelvis had multiple abnormal masses in the left ilium, pubis, ischial and acetabular regions . ECT showed that an imaging agent was deposited in the right mandible and in the left pelvis. Both the PET/CT and the ECT indicated that the patient had a malignant tumour in her left pelvis. After the general physical checkup, the patient recalled that she had been suffering from hip pain since past two years. This "indisposition" had been ignored by her earlier, as she had been apprehensive that it had been post-menopausal osteoporosis. However, it could have been reasonably attributable to the tumour which had been identified. The radical operation of hemi-dilectomy was performed [Table/ Fig-4a,4b]. The specimen showed that the tumour had originated from the bone. It was invasive, pale and expanded to the surfa...

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Unknown primary

Cited by 44 publications

References 68 publications

The Role of 18 FDG PET-CT in Evaluation of Unknown Primary Tumours

The Role of 18 FDG PET-CT in Evaluation of Unknown Primary Tumours

Occult Primary

Osteosarcoma of the Jaws: Case Report on Synchronous Multicentric Osteosarcomas

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