Unknown primary adenocarcinomas: a single-center experience

Uzunoğlu, Sernaz; Erdoğan, Bülent; Kodaz, Hilmi; Cinkaya, Ahmet; Türkmen, Esma; Hacıbekiroğlu, İlhan; Sari, Ali Osman; Özen, Alaattin; Usta, Ufuk; Çiçin, İrfan

doi:10.17305/bjbms.2016.1495

Cited by 8 publications

(10 citation statements)

References 23 publications

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“…This percentage is very similar to previous experiences from Western countries i.e. in previous reports, the origin of 25% -35% of metastatic liver cancers was unknown (11,12).…”

Section: Discussionsupporting

confidence: 91%

The Origin of Liver Metastatic Adenocarcinomas, a Single Center Experience from the South of Iran

Geramizadeh

Abdi

2019

Hepat Mon

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Background: Liver is one the most common sites of metastasis, and metastatic liver cancers are the most common liver malignancies. Metastatic adenocarcinomas are the most common metastatic liver cancers, which have different origins. The liver biopsy is a very important step to find the origin of metastatic cancer by immunohistochemistry. Objectives: In this study, we aimed to find the primary origin of metastatic adenocarcinomas in the liver biopsies. Methods: In this study, 210 liver biopsies with the primary diagnosis of metastasis with unknown origin in the liver were investigated from 2008 to 2017 that 126 cases (60%) of which have proved to be metastatic adenocarcinoma with unknown origin. Histologic studies and immunohistochemical (IHC) stains were performed. Also, a complete endoscopic, radiologic, clinical, and paraclinical studies were carried out besides the liver biopsy to find the origin of the adenocarcinoma. Results: Among these 126 liver biopsies, the origin of 94 cases (74.6%) was definitely determined by IHC and other examinations mentioned above. All efforts for thirty-two cases (25.4%) failed to find the primary origin despite a complete examination. Most common primary origins were colon (23.8%), lung (19%), pancreas (13.9%), and breast (11.2%). Conclusions: Performing a liver biopsy is a very helpful modality to find the origin of liver metastatic adenocarcinoma but needs to be combined with other clinical findings and diagnostic modalities to find the origin of metastasis to the liver. By combining these methods, our study showed that the origin of 74.6% of metastatic liver adenocarcinomas can be found, which is most commonly from colon, lung, and pancreas.

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“…This percentage is very similar to previous experiences from Western countries i.e. in previous reports, the origin of 25% -35% of metastatic liver cancers was unknown (11,12).…”

Section: Discussionsupporting

confidence: 91%

The Origin of Liver Metastatic Adenocarcinomas, a Single Center Experience from the South of Iran

Geramizadeh

Abdi

2019

Hepat Mon

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“…It has the most aggressive behavior and is highly resistant to therapy. A better understanding of treatment and prognostic factors is possible by studying patients in homogenous subgroups with CUP [7].…”

Section: Reviewmentioning

confidence: 99%

“…A new therapeutic method based on molecular profiling associated with treatment benefit in 96% of the cases is proposed. Hence, expressing the wide-range of biomarker profiling using gene sequencing, immunohistochemistry, and in situ hybridization method identifies biomarkers [23]. In comprehensive genomic profiling, it is observed that there is at least one clinically appropriate genomic alteration in CUP that can influence the targeted therapy [24].…”

Section: Reviewmentioning

confidence: 99%

Cancer of Unknown Primary: A Review on Clinical Guidelines in the Development and Targeted Management of Patients with the Unknown Primary Site

Qaseem¹,

Usman²,

Jayaraj³

et al. 2019

Cureus

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Cancer of unknown primary (CUP) is a malignant widespread metastatic disease without an identifiable primary site after extensive clinical investigation. Recently, a decline is observed in the diagnosis of CUP, mainly due to improvement in detection of the primary tumors, thus decreasing the unknown primaries. Worldwide, CUP is the sixth to eighth most common malignancy, accounting for 2.3% to 5% of a new cancer diagnosis. CUP is third to fourth most common cause of death due to cancer-related mortality. The prognosis of CUP is depressing with the median survival of three to six months in the previous studies, but according to recent studies, median survival is less than one year. High risk for developing CUP is seen in heavy smokers (26 or more cigarettes/day) and individuals with the lowest quartiles of waist circumference. A weak association is observed with the use of alcohol consumption and low level of education. Human papillomavirus DNA plays a role in those with squamous cell carcinoma of unknown primaries in head and neck regions. In the diagnosis of CUP, comprehensive medical history, complete physical examination (including genitourinary, rectal exam, and breast examination in women) and necessary laboratory tests are crucial.Whole-body positron emission tomography-computed tomography (PET/CT) is the investigation of choice to assess the entire body for CUP. Multiparametric 3T-MRI (MP-MRI) is used to examine the local soft tissue status, helps in the staging of the tumor, and to determine the extent of involvement of tissue for medical as well as prognostic purposes. Immunohistochemistry outlines the specific markers, including caudal-related homeobox protein (CDX2), homeobox protein Nkx-3.1 (NKX3-1), paired box gene 8 (PAX8), special AT-rich sequence-binding protein 2 (SATB2), thyroid transcription factor 1 (TTF-1), and splicing factor 1 (SF1) with the focus on the effectiveness of lineage-restricted transcription factors. Patients response to treatment can be evaluated by the gene expression profiling (GEP) test that also predicts tissue of origin (TOO). Tumor identified through gene profiling is sensitive to platinum/taxane therapy, others that are not TOO tumors are resistant to platinum/taxane. The new therapeutic method based on molecular profiling is associated with higher treatment response. In comprehensive genomic profiling, it is observed that there is at least one clinically appropriate genomic alteration in CUP that can influence the targeted therapy. The targeted therapeutic approach will not only improve the disease outcome but will also be cost-effective and save time from finding the primary site.

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“…However, survival outcomes in CUP patients remain poor [21]. To ensure that patients with CUP can receive optimal care, identification of genetic abnormalities in addition to existing surveillance is urgently needed [2, 20, 22].…”

Section: Discussionmentioning

confidence: 99%

Identification of a metastatic lung adenocarcinoma of the palate mucosa through genetic and histopathological analysis: a rare case report and literature review

Abe¹,

Watanabe²,

Shinozaki‐Ushiku³

et al. 2019

BMC Cancer

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BackgroundCancers of unknown primary origin (CUPs) are reported to be the 3-4th most common causes of cancer death. Recent years have seen advances in mutational analysis and genomics profiling. These advances could improve accuracy of diagnosis of CUPs and might improve the prognosis of patients with CUPs.Case presentationA 76-year old male with an adenocarcinoma of unknown primary origin in the lung presented with another tumor of the palate mucosa. The tumor cells in the pleural effusion were all negative for immunohistochemical markers (TTF-1 and Napsin A) and lung-specific oncogenic driver alterations (EGFR mutation and ALK translocation). The tumor of the palate mucosa was likewise identified as an adenocarcinoma, and the cells showed cytological similarities with the tumor cells in the pleural effusion; TTF-1, Napsin A, EGFR mutation and ALK translocation were all negative. This result suggested that origins of the tumors of the palate mucosa and in the lung were the same, even though the origin had not yet been determined. Next, we addressed whether the tumor of the palate mucosa was a primary tumor or not. Secretory carcinoma (SC), which is a common type of minor salivary gland tumor (MSGT), was suspected; however, mammaglobin was negative and ETV6-NTRK3 (EN) fusion was not observed. Other MSGTs were excluded based on histological and immunohistochemical findings. Furthermore, an additional examination demonstrated an oncogenic KRAS mutation at codon 12 (p.G12D) in both palate tumor and in pleural effusion. KRAS mutation is known to exist in one-third of lung adenocarcinomas (LUADs), but quite rare in MSGTs. The possibility of metastasis from other organs was considered unlikely from the results of endoscopic and imaging studies. This result indicated that the primary site of the CUP was indeed the lung, and that the tumor of the palate mucosa was a metastasis of the LUAD.ConclusionsA tumor of the palate mucosa that showed diagnostic difficulties was determined to be a metastatic LUAD by genomic alterations and histopathological findings.Electronic supplementary materialThe online version of this article (10.1186/s12885-019-5277-1) contains supplementary material, which is available to authorized users.

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Unknown primary adenocarcinomas: a single-center experience

Cited by 8 publications

References 23 publications

The Origin of Liver Metastatic Adenocarcinomas, a Single Center Experience from the South of Iran

The Origin of Liver Metastatic Adenocarcinomas, a Single Center Experience from the South of Iran

Cancer of Unknown Primary: A Review on Clinical Guidelines in the Development and Targeted Management of Patients with the Unknown Primary Site

Identification of a metastatic lung adenocarcinoma of the palate mucosa through genetic and histopathological analysis: a rare case report and literature review

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