Abstract
BackgroundTumor spread beyond the peritoneal cavity in cases of papillary serous adenocarcinoma of the unknown primary (CUP) is a rare late event and carries a poor prognosis.Case presentationA 71-year-old female was referred to our hospital because of a large right inguinal tumor with biopsy evidence of carcinoma as well as an elevated serum CA125 (cancer antigen 125). She underwent complete resection of the right inguinal tumor and multiple pelvic tumors, which involved the rectum, ovary and uterus. Pathological examination revealed the tumors to be metastases of a papillary serous adenocarcinoma with a psammoma body of CUP. On the 28th postoperative day, newly developed asymptomatic small left inguinal node metastases in the setting of a normal CA125 level were removed. Four and a half years after the primary resection, the CA125 level increased again and newly developed asymptomatic metastases were found in the right deep inguinal nodes and extirpated at that time. All surgical resections followed the modified FAM (5FU, Adriamycin; ADM, MMC) regimen, including protracted dairy oral administration of UFT or 5'-FDUR, Cimetidine and PSK (protein-bound polysaccharide K) as an immunomodulator or biological response modifier in conjunction with intermittent one-day continuous infusion (ADM+MMC) or intermittent single bolus injection of ADM+MMC. At present, the patient has been living in good health for almost 7 years with no evidence of relapse.ConclusionAggressive resection surgery followed by effective adjuvant chemotherapy is necessary for surviving long time without relapse of poorly prognostic patients with metastases outside of the abdominal cavity from peritoneal papillary serous adenocarcinomas.
Highlights
Tumor spread beyond the peritoneal cavity in cases of papillary serous adenocarcinoma of the unknown primary (CUP) is a rare late event and carries a poor prognosis.Case presentation: A 71-year-old female was referred to our hospital because of a large right inguinal tumor with biopsy evidence of carcinoma as well as an elevated serum CA125
Despite recent advances in diagnostic imaging and molecular pathology, CUP accounts for about 3 % of all malignant neoplasms, which represent a group of heterogeneous tumors sharing unique clinical characteristics of metastatic epithelial cancers with no identifiable origin even on autopsy [1]
Cancer cells show micropapillary growth pattern into the lymphatic node and many Psammoma bodies are evident. These findings indicate metastasis of serous papillary adenocarcinoma
Summary
Despite recent advances in diagnostic imaging and molecular pathology, CUP accounts for about 3 % of all malignant neoplasms, which represent a group of heterogeneous tumors sharing unique clinical characteristics of metastatic epithelial cancers with no identifiable origin even on autopsy [1]. Cancer cells show micropapillary growth pattern into the lymphatic node and many Psammoma bodies (hallow arrow) are evident. These findings indicate metastasis of serous papillary adenocarcinoma. From 4.5 years after the last surgery, the serum level of CA-125 had gradually elevated to 140.5 U/ ml and the CT scans demonstrated newly developed asymptomatic single tumor growth (25 × 20 mm) on the right deep inguinal node (Fig. 3), though no evident tumor was found anywhere else in the body. Pathologic examination revealed that papillary serous adenocarcinoma cells were growing in the lymph node in a micropapillary pattern and many psammoma bodies were recognized (Fig. 2D). No adverse effects were encountered at any time during the clinical course (Fig. 3) and the patient is living well, disease-free almost 7 years after the primary tumor resection
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