Poorly differentiated adenocarcinoma of an unknown primary with a thyroid tumour and an aggressive course: thyroid or lung carcinoma?

PURPOSE The objectives of this study were to assess clinical outcomes and prognostic factors in unselected, consecutive patients with poorly differentiated carcinoma (PDC) or poorly differentiated adenocarcinoma (PDA). PATIENTS AND METHODS The 1,400 patients analyzed were referred to our unknown-primary tumor (UPT) clinic from January 1, 1987 through July 31, 1994. Clinical data from these patients were entered into a computerized data base for storage, retrieval, and analysis. Survival was measured from the time of diagnosis; survival distribution was estimated using the product-limit method. Multivariate survival analyses were performed using proportional hazards regression and by recursive partitioning. RESULTS Nine hundred seventy-seven patients were diagnosed with unknown-primary carcinoma (UPC) and 337 of these patients had PDC or PDA. No clinical differences were identified among patients with PDC, PDA, or UPC patients with other carcinoma or adenocarcinoma subtypes. PDC patients enjoyed better survival than PDA patients. Poor cellular differentiation was not an important prognostic variable. Variables predictive of survival included lymph node metastases, sex, number of metastatic sites, histology (PDC v PDA), and age. Although chemotherapy did not appear to influence survival for the entire group of PDC or PDA patients, a subset of patients with good prognostic features experienced median survival durations of up to 40 months. CONCLUSION The long median survival and chemotherapy responsiveness of UPC patients with PDC and PDA could not be confirmed. However, subpopulations with prolonged median survival durations could be defined, and the value of chemotherapy in this group remains to be determined. Identification and exclusion of treatable or slow-growing malignancies may account for the poor survival of the PDC and PDA patients reported in this study.

Download Full-text

Metastatic carcinoma of unknown primary with complete metabolic response following sorafenib-based chemotherapy

SAGE Open Medical Case Reports ◽

10.1177/2050313x19838739 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1983873

Author(s):

Pedro Luiz Serrano Usón Junior ◽

Jairo Wagner ◽

Marcus Vinicius de Nigro Corpa ◽

Iracema Moraes Coelho ◽

Robert A Nagourney ◽

...

Keyword(s):

Cellular Response ◽

Metabolic Response ◽

Metastatic Carcinoma ◽

Medical Attention ◽

Unknown Primary ◽

Complete Metabolic Response ◽

Poorly Differentiated Adenocarcinoma ◽

Genetic Profiling ◽

Carcinoma Of Unknown Primary ◽

Poorly Differentiated

Background: The treatment of carcinoma of unknown primary based on histopathology and immunohistochemistry is generally chemotherapy. The use of molecular markers, genetic profiling platforms, and personalized medicine is under active investigation. Case Report: We report the case of a 56-year-old patient who presented to medical attention with palpable axillary adenopathy. Biopsy confirmed poorly differentiated adenocarcinoma. Formal staging revealed extensive metastatic disease to bone and liver. Initial chemotherapy proved ineffective. We describe the diagnostic evaluation, treatment, and achievement of durable remission using a novel sorafenib-based drug combination that was chosen through the application of a functional analytic laboratory platform. Conclusion: The clinical management of patients with carcinoma of unknown primary continues to present a considerable challenge for practicing oncologists. Laboratory platforms capable of examining cellular response to injury, growth factor withdrawal, and cytotoxic insult at the level of cellular function may provide insights for drug selection in this patient population.

Download Full-text

A case of pancreatic metastasis arising from occult lung cancer

Case Reports in Internal Medicine ◽

10.5430/crim.v5n2p21 ◽

2018 ◽

Vol 5 (3) ◽

pp. 21

Author(s):

Ryo Kodama ◽

Hisanobu Saegusa ◽

Hiroyasu Ushimaru ◽

Mutsuki Makino ◽

Kenji Kawaguchi

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Primary Lung Cancer ◽

Pancreatic Mass ◽

Pancreatic Metastasis ◽

Unknown Primary ◽

Cancer Tissue ◽

Poorly Differentiated Adenocarcinoma ◽

Small Nodule ◽

Poorly Differentiated

A 57-year-old man was admitted with complaints of stiffness on the right clavicle. Imaging study revealed swelling of multiple lymph nodes and pancreatic mass, but there were no such findings in the lung. Endoscopic ultrasound-guided fine needle aspiration for mediastinum lymph node and pancreatic mass revealed a poorly differentiated adenocarcinoma. He was diagnosed of pancreatic cancer with multiple lymph node metastases. Chemoradiotherapy was conducted. Six months later, he suffered from cardiac tamponade and died. The autopsy revealed a small nodule of poorly differentiated adenocarcinoma in the lung that could not be pointed out by computed tomography. Immunohistochemistry showed that both tumors of the lung and pancreas were positive for thyroid transcription factor-1 and napsin A, which are specific markers of lung cancer. Final diagnosis was primary lung cancer with metastases to the pancreas and heart. Pancreatic metastasis from occult lung cancer is rare. Lung cancer must be suspected when carcinoma of unknown primary is detected, even in the absence of the image findings of the lung. Immunostaining is useful in determining the primary site; hence, obtaining the cancer tissue is important.

Download Full-text

Cisplatin-based combination chemotherapy in the treatment of poorly differentiated carcinoma and poorly differentiated adenocarcinoma of unknown primary site: results of a 12-year experience.

Journal of Clinical Oncology ◽

10.1200/jco.1992.10.6.912 ◽

1992 ◽

Vol 10 (6) ◽

pp. 912-922 ◽

Cited By ~ 92

Author(s):

J D Hainsworth ◽

D H Johnson ◽

F A Greco

Keyword(s):

Prognostic Factors ◽

Lymph Nodes ◽

Tumor Location ◽

Primary Site ◽

Unknown Primary ◽

Unknown Primary Site ◽

Poorly Differentiated Adenocarcinoma ◽

Poorly Differentiated Carcinoma ◽

Peripheral Lymph ◽

Poorly Differentiated

PURPOSE We previously reported excellent responses to cisplatin-based chemotherapy in a minority of patients with poorly differentiated carcinoma (PDC) or poorly differentiated adenocarcinoma (PDA) of unknown primary site. We have continued to study and to treat these patients, and now report clinical characteristics, treatment results, and prognostic factors in a large group of patients identified prospectively. PATIENTS AND METHODS Between February 1978 and December 1989, we treated 220 patients with PDC or PDA of unknown primary site. The median age was 39 years; 48% of patients had predominant tumor location in the mediastinum, retroperitoneum, or peripheral lymph nodes. Specialized pathologic studies resulted in the identification of specific tumor types in only a few cases. All patients received cisplatin-based chemotherapy; between 1978 and 1984, 116 patients received cisplatin, vinblastine, and bleomycin (PVeB) +/- doxorubicin, and 104 patients treated since January 1985 received cisplatin and etoposide +/- bleomycin. RESULTS One hundred thirty-eight patients (63%) had objective responses to therapy, and 58 (26%) had complete response. Thirty-six patients (16%) are currently disease-free at a median of 61 months following therapy (range, 11 to 142 months). Actuarial 10-year survival is 16%. Favorable prognostic factors identified by Cox regression analysis include: (1) predominant tumor location in the retroperitoneum or peripheral lymph nodes, (2) tumor limited to one or two metastatic sites, (3) no history of cigarette use, and (4) younger age. CONCLUSION Patients with PDC or PDA of unknown primary site represent another group of patients for whom potentially curative therapy is available. Patients with this syndrome should be distinguished from patients with well-differentiated adenocarcinoma of unknown primary site, and should receive a trial of cisplatin-based chemotherapy.

Download Full-text

Overexpression of Her-2 in Patients With Poorly Differentiated Carcinoma or Poorly Differentiated Adenocarcinoma of Unknown Primary Site

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.3.632 ◽

2000 ◽

Vol 18 (3) ◽

pp. 632-632 ◽

Cited By ~ 61

Author(s):

John D. Hainsworth ◽

Wayne J. Lennington ◽

F. Anthony Greco

Keyword(s):

Tumor Location ◽

Primary Site ◽

Immunohistochemical Method ◽

Unknown Primary ◽

Unknown Primary Site ◽

Poorly Differentiated Adenocarcinoma ◽

Carcinoma Of Unknown Primary ◽

Poorly Differentiated Carcinoma ◽

Poorly Differentiated ◽

Her 2

PURPOSE: To determine the frequency of Her-2 overexpression in patients with poorly differentiated carcinoma or poorly differentiated adenocarcinoma of unknown primary site. PATIENTS AND METHODS: Tumor specimens from 100 patients with poorly differentiated carcinoma or poorly differentiated adenocarcinoma were stained for the Her-2 protein using the Dako immunohistochemical method. Clinical and pathologic characteristics of patients with and without Her-2 overexpression were compared. RESULTS: Staining for Her-2 overexpression was successful in 94 of 100 patients. Ten (11%) of 94 tumor specimens overexpressed Her-2. Eight of 10 overexpressors had poorly differentiated adenocarcinoma, and all overexpressors had predominant tumor location above the diaphragm, usually in the mediastinum or lungs. CONCLUSION: Her-2 overexpression occurs in a minority of patients with poorly differentiated carcinoma/adenocarcinoma of unknown primary site. Because most overexpressors had poorly differentiated adenocarcinoma, further evaluation of patients with adenocarcinoma of unknown primary site is necessary to determine the frequency of Her-2 overexpression in this common subgroup. Evaluation of the efficacy of trastuzumab in Her-2 overexpressors with carcinoma of unknown primary site is indicated.

Download Full-text

METASTASIS OF AN ADENOCARCINOMA OF THE STOMACH TO THE 4TH METACARPAL BONE

Hand Surgery ◽

10.1142/s0218810401000515 ◽

2001 ◽

Vol 06 (02) ◽

pp. 239-242 ◽

Cited By ~ 6

Author(s):

H. C. Chang ◽

K. H. Lew ◽

C. O. Low

Keyword(s):

Metastatic Lesion ◽

Metacarpal Bone ◽

Review Of The Literature ◽

Poorly Differentiated Adenocarcinoma ◽

Poorly Differentiated ◽

The Right

Metastatic tumours of the hand are uncommon. The majority of these tumours affect the phalanges and the primary tumours are usually bronchogenic in origin, with breast and kidney tumours next in frequency. Metastatic gastrointestinal to the hand is rare and usually from the colon. We report a case of poorly differentiated adenocarcinoma of the stomach antrum presenting with a metastatic lesion to the right 4th metacarpal bone. A review of the literature is included.

Download Full-text

Poorly differentiated adenocarcinoma positive for gross cystic disease fluid protein-15 in the lacrimal drainage system: a case report and its implications for tumour origin

Eye ◽

10.1038/eye.2008.299 ◽

2008 ◽

Vol 23 (8) ◽

pp. 1740-1741 ◽

Cited By ~ 2

Author(s):

Y Murakami ◽

R I Kohno ◽

H Yoshikawa ◽

M Takeshita ◽

K Sueishi ◽

...

Keyword(s):

Case Report ◽

Drainage System ◽

Cystic Disease ◽

Poorly Differentiated Adenocarcinoma ◽

Lacrimal Drainage System ◽

System A ◽

Poorly Differentiated ◽

Cystic Disease Fluid Protein ◽

Tumour Origin ◽

Lacrimal Drainage

Download Full-text

A Case of Collision Tumor of Primary Malignant Lymphoma and Poorly-differentiated Adenocarcinoma in the Ascending Colon

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.37.213 ◽

2004 ◽

Vol 37 (2) ◽

pp. 213-216 ◽

Cited By ~ 6

Author(s):

Eiji Minato ◽

Ippei Fujino ◽

Nobuhito Sugihira ◽

Kazuo Matsumoto ◽

Kouichi Shima

Keyword(s):

Malignant Lymphoma ◽

Collision Tumor ◽

Ascending Colon ◽

Poorly Differentiated Adenocarcinoma ◽

Poorly Differentiated

Download Full-text

You can’t judge a book by its cover or a tumor by its expression profile

Clinics and Practice ◽

10.4081/cp.2012.e21 ◽

2012 ◽

Vol 2 (1) ◽

pp. 21

Author(s):

Steven M. Sorscher ◽

Theodore Thomas

Keyword(s):

Expression Profile ◽

Expression Profiling ◽

Radiographic Progression ◽

Clinical Course ◽

Unknown Primary ◽

Great Promise ◽

Primary Tumors ◽

Remarkable Case ◽

Rate Of Progression ◽

Poorly Differentiated

Expression profiling has shown great promise in matching cancers of unknown primary to likely primary tumors of origin based on patterns of mRNA expression. However, it remains uncertain as to whether even well matched tumors will demonstrate the clinical features, such as rate of progression, of their matched counterparts. In this case report, we note that based on histology, immunohistochemistry and expression profile this patient’s poorly differentiated neuroendocrine tumor would have been expected to grow very rapidly on no therapy. Instead, this cancer was very indolent, with only very little radiographic progression over several years. We believe this report represents a remarkable case of a tumor where features, including expression profile, would not at all have accurately predicted the clinical course seen. While some series have suggested that matching by expression profiling predicts outcome, this case shows a dramatically different result.

Download Full-text