Adenocarcinoma Of Unknown Origin Research Articles

Pelvic mass: CT-guided interstitial catheter implantation with high-dose-rate remote afterloader.

A technique is presented for computed tomography (CT)-guided interstitial catheter placement and treatment planning for high-dose-rate brachytherapy. In a 66-year-old woman with adenocarcinoma of unknown origin that had metastasized to the right ilium, interstitial brachytherapy catheters were placed by means of CT guidance. With use of a treatment planning system with dose optimization, an excellent dose distribution was obtained with minimal dose being delivered to the surrounding critical tissues. For selected patients, this procedure can provide effective and safe local treatment for solid tumors.

Calcified Brain Metastasis

Two patients with rare cases of calcified brain metastases are reported. The relatively benign clinical course and prolonged survival are stressed. The first patient had an adenocarcinoma of unknown origin with three calcified brain metastases. The patient underwent an incisional brain biopsy without radiotherapy and survived for 2 years and 9 months. The second patient had a squamous cell carcinoma of the lung with a large, solitary brain metastasis. The brain tumor was calcified and remained stable without progression for at least 4 months before surgical resection.

Adenocarcinoma of Unknown Origin in a Patient with Primary Intestinal Lymphangiectasia

Adenocarcinoma of Unknown Origin in a Patient with Primary Intestinal Lymphangiectasia

Ultrasound guidance for biopsy of omental abnormalities.

We review our two-year experience with ultrasound-guided fine needle aspiration biopsy of omental pathology. Eleven patients were referred for biopsy of omental abnormalities. Biopsy was performed without complication in all cases and the aspirates were positive for malignancy in 9. The discharge diagnosis was ovarian carcinoma in 6 patients, adenocarcinoma of unknown origin in 1, lymphoma in 1, and carcinoma of the colon in 1. The technique requires the use of a linear array transducer for biopsy guidance, and is safe, rapid, and easy to perform.

Radiosurgery for solitary brain metastases using the cobalt-60 gamma unit: methods and results in 24 patients

To define the role of stereotactic radiosurgery in the treatment of metastatic brain tumors we treated 24 consecutive patients (20 men, 4 women) with the 201-source 60Co gamma unit between May 1988 and March 1990. The primary tumors included malignant melanoma (n = 10), non-small cell lung carcinoma (n = 6), renal cell carcinoma (n = 3), colorectal carcinoma (n = 1), oropharyngeal carcinoma (n = 1), and adenocarcinoma of unknown origin (n = 3). All tumors were ≤3.0 cm in greatest diameter. Twenty patients received a planned combination of 30–40 Gy whole brain fractionated irradiation and a radiosurgical “boost” of 16–20 Gy to the tumor margins; one patient refused conventional fractionated irradiation. Three patients with recurrent, persistent, or new non-small cell lung carcinomas had radiosurgical treatment 12–20 months after receiving 30–42.5 Gy whole-brain external beam irradiation. Stereotactic computed tomographic imaging was used for target coordinate determination and imaging-integrated dose planning. All tumors were enclosed by the 50–90% isodose shell using one (n = 22), two (n = 1), or three (n = 1) irradiation isocenters. During this 23-month period (median follow-up of 7 months) no patient died from progression of a radiosurgically-treated brain metastasis. Ten patients died of systemic disease (n = 8) or remote central nervous system metastasis (n = 2) between 1 week and 10 months after radiosurgery. One patient had tumor progression and underwent craniotomy and tumor excision 5 months after radiosurgery. To date, median survival after radiosurgery has been 10 months; 1-year survival was 33.3%. Stereotactic radiosurgery eliminated the surgical and anesthetic risks associated with craniotomy and resection of solitary brain metastases. Radiosurgery also effectively controlled the growth of tumors considered “resistant” to conventional irradiation.

Clinical Diagnosis for Metastatic Adenocarcinoma of Spine of Unknown Origin

The diagnostic values of the presence of Virchow's node (VN) or rectal shelf (RS) in spinal metastasis from adenocarcinoma of unknown origin were studied prospectively in 60 patients during 1986-1988. These were compared with 14 cases with other malignancies of the spine and 37 controls with nonneoplastic spinal lesions. The diagnosis was confirmed by histologic study in all malignant cases. The results were analyzed by diagnostic test analysis and McNemar chi 2 testing. This yields 18.3-21.6%, 97.2-100%, and 92.8-100% sensitivity, specificity, and predictive value, respectively, for a positive test for VN and RS to differentiate significantly adenocarcinoma from other malignancies and control patients (P less than 0.005). These findings may thus be considered as a simple and economic guide for physicians to determine the proper approach to patients with a spinal lesion suspected to be malignant.

Immunohistochemistry in the Differential Diagnosis of Liver Carcinomas

Immunohistochemical techniques were used to study 177 hepatic tumors (hepatocarcinoma, cholangiocarcinoma, hepatocholangiocarcinoma, adenocarcinoma of unknown origin, and metastatic carcinoma). Phenotypes suggestive of hepatocarcinoma included keratins 8 and 18, factor XIII a, alpha-fetoprotein. C-reactive protein, carcinoembryonic antigen (CEA) cross-reacting antigen; those in effect that excluded hepatocarcinoma were keratins 1, 5, 10, 11, 19, true CEA. C-reactive protein, used for the first time, proved to be a fairly sensitive and specific marker. Factor XIII a, which was thought to be synthesized only by histiocytes, was also present in hepatocytes. Immunohistochemistry appears to be an important tool in the diagnosis of hepatic tumors. As a result of this study, 32 cases were reclassified; several were found to be intermediate between hepatocarcinoma and cholangiocarcinoma. Sixteen cases apparently were true hepatocholangiocarcinomas. In 12 cases of hepatocarcinoma, some tumor cells expressed keratins of bile duct type. It was impossible to differentiate immunohistochemically cholangiocarcinoma from metastatic carcinoma, except in two cases with breast tissue markers.

Incidentally Discovered Mass of the Adrenal Gland

Increasing numbers of asymptomatic masses of the adrenal gland are being discovered by high resolution computed tomography (CT) scanning. The significance of these masses and the question of further evaluation or treatment, or both, have posed a dilemma. From 1976 to 1983, an incidental finding of adrenal gland mass was identified in 88 patients undergoing abdominal CT scanning for unrelated problems. Adrenelectomy was performed upon 23 patients (26 per cent), including three adenomas (2.5, 3.0 and 6.5 centimeters), five carcinomas of the adrenal gland (6 to 20 centimeters), two hyperplasias and three adenocarcinomas of unknown origin. Thirty-eight (43 per cent) of the nonfunctioning masses were observed with repeat scans for an average of 25.1 months (three to 60 months), revealing no change in size. Twenty-seven patients (31 per cent) were lost to follow-up study. Silent primary (nonmetastatic) masses 3.5 centimeters or less manifested benign behavior without exception. Based upon these data, we conclude that all solid metabolically inactive lesions in the adrenal glands greater than 3.5 centimeters on CT abdominal scan deserve exploration. Lesions less than 3.5 centimeters may be safely followed with serial CT scans.

Enzyme-linked immunochemical measurement of estrogen receptor in gynecologic tumors, and an overview of steroid receptors in ovarian carcinoma.

We tested whether a newly available enzyme-linked immunoassay (EIA) validly measures estrogen receptor (ER) in gynecologic tumors. We first documented that ER so measured agreed with results by established radioligand-based assays [dextran-coated charcoal (DCC) and hydroxylapatite (HAP)] for in-house breast carcinomas and for proficiency testing specimens. Then, for gynecologic tumors, we found strong correlations between results for ER as measured by the two methods; e.g., for 27 ovarian carcinomas, r greater than or equal to 0.86. The same was true for ER measured in nine specimens of ovarian carcinoma from women who had undergone chemotherapy: r greater than or equal to 0.94. Radioinert estradiol or serum had no discernible effect on EIA measurements of ER, whereas our DCC assay was rendered uninterpretable. Evidently the EIA validly measures ER in steroidogenic tissues, including ovarian, and also in breast and uterine carcinomas. Clinical management of the latter is now based in part on results of steroid receptor assays. For ovarian carcinomas, ER assay can be helpful for determining the probable primary site of adenocarcinomas of unknown origin, and it is providing a rational basis for development of new diagnostic and therapeutic strategies.

Visualization of metastases from colon carcinoma using an lodine 131-radiolabeled monoclonal antibody

A murine monoclonal antibody that reacts with human colonic cancer (250-30.6) was labeled with radioactive iodine (131I) and the antibody was injected intravenously into 15 patients with known metastases originating from carcinoma of the colon (10 cases), malignant melanoma (1), breast (1), pancreas (1), hepatocellular carcinoma (1), and adenocarcinoma of unknown origin (1). Of the patients with metastatic colon carcinoma, there were 19 known deposits as judged by the techniques of clinical examination, x-rays, and scans obtained using sulpha-colloid. Of these 19 deposits, 17 (90%) were found using the 131I-labeled monoclonal antibody. In one case, the primary tumor, previously undiagnosed, was found. In only 1 of the 10 patients was tumor not found and this was due to the subsequent finding that the undifferentiated tumor did not react with antibody. Of the five patients who did not have carcinoma of the colon, three had negative scans, but two were positive. Thus, the technique of immunoscintography can readily detect both primary and metastatic tumors.

Metastatic lid disease

Metastatic lid disease is a rare cutaneous occurrence presenting as diffuse lid swelling or a localized nodule. The breast in women, the gastrointestinal and respiratory systems in men constitute the commonest primary sites. Lid spread usually occurs late but may occasionally be the first sign of metastasis. The case of a 60-year-old man with upper lid retraction secondary to metastatic adenocarcinoma of unknown origin is presented.

Electron microscopy in determining origin of metastatic adenocarcinomas.

Light microscopy has limited value in predicting where the primary site of a metastatic adenocarcinoma might be located. In our series, electron microscopy was useful in determining the primary site in approximately 85% of patients with a metastatic adenocarcinoma of unknown origin. This study is based on the ultrastructural examination of more than 100 such cases. In the remaining 15% of the cases, electron microscopy usually provided assistance in reducing the differential diagnosis to a minimum, usually to two possible primary sites. The majority of the metastatic adenocarcinomas showed rather specific ultrastructural features to suggest the site of origin. This application of electron microscopy has never been fully explored and has considerable clinical importance and economic impact in health care systems. An extensive work-up to determine the primary site, with its inconvenience to patient and family, as well as delay in adequate treatment, can be avoided with early diagnosis of the primary site.

Adenocarcinoma of unknown origin.

Adenocarcinoma of unknown origin.

Adenocarcinoma of Unknown Primary Origin

Seventy-seven cases of adenocarcinoma of unknown origin were studied retrospectively. Pain was the most common presenting symptom and lymphadenopathy was the most common finding on physical examination. Tumor involved several organs in two thirds of the patients, the lung being the most frequently involved. Complete surgical resection was possible in only four of 27 patients with single organ involvement. All four patients had lymph node dissections and remain free of disease after one to three years. Four patients with tumor confined to the liver received infusion of antitumor agents through the hepatic artery which resulted in objective tumor regression in all, and regression of greater than 50% in two. Forty-three trials of systemic intravenous chemotherapy were administered to 38 patients with nonresectable tumor resulting in greater than 50% tumor regression in eight. Responses were more frequent with regimens containing adriamycin plus either cyclophosphamide or cis-platinum. Median survival of all patients in the study was 31 weeks. Patients who received chemotherapy survived significantly longer (median 41 vs 26 weeks, P = 0.005). Similarly, patients who responded to chemotherapy survived significantly longer than nonresponders (median 54 vs 27 weeks, P less than 0.02). Our results indicate that early treatment of patients with adenocarcinoma of unknown origin improves their prognosis.

Activity of 9-10 anthracenedicarboxaldehyde bis[(4,5-dihydro-1 H-imidazol-2-yl)hydrazone]dihydrochloride (CL216,942) in a human tumor cloning system. Leads for phase II trials in man.

We have utilized a recently developed human tumor cloning system to screen for antitumor effects in vitro of a new anthracene derivative, CL216,942. The object was to determine whether the system is useful for pinpointing the types of tumors in patients which should be studied in early phase II clinical trials. Tumors from 684 patients were placed in culture (27 different histologic tumor types). Two hundred seventy-three tumors both grew and formed enough colonies for drug sensitivity assays. In vitro antitumor activity was noted for CL216,942 against human breast cancer, ovarian cancer, renal cancer, squamous cell, small cell and large cell lung cancer, lymphoma, acute myelogenous leukemia, melanoma, adenocarcinoma of unknown origin, adrenal cancer, gastric cancer, pancreatic cancer, and head and neck cancer. The drug definitely showed no in vitro activity against colon cancer. These data indicate that CL216,942 has a wide spectrum of in vitro antitumor activity. A comparison of these in vitro results with the results of phase II clinical trials with the drug should allow an evaluation of the utility of the human cloning system for predicting clinical activity of a new compound.

Adenocarcinoma of Unknown Origin

Editorial Notes1 October 1979Adenocarcinoma of Unknown OriginCHARLES G. MOERTEL, M.D.CHARLES G. MOERTEL, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-91-4-646 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptA frequently encountered and challenging clincial problem is that of the patient presenting with evidence of metastatic disease but with no clinically apparent primary site. If biopsy of distant metastasis reveals adenocarcinoma, one must assume that it represents advanced cancer not curable by present methods. Under these circumstances, is a search for the primary tumor no more than a nonproductive academic exercise?This question was recently addressed by the oncology group at the Ludwig Institute, Sydney, Australia, in a review of records of 87 patients who presented with metastatic adenocarcinoma with the primary site undetected by history, physical examination, and...

Adenocarcinoma of unknown origin. A rational approach to a diagnostic puzzle.

Determination of the tissue of origin of disseminated adenocarcinoma is often difficult. Careful clinical evaluation of the patient in light of known characteristics of certain primary tumors, followed by appropriate screening tests, may yield decisive information. If not, a decision for or against more specific tests must be made.

Malignancy in Association with Polymyalgia Rheumatica and Temporal Arteritis

In a series of 45 patients with polymyalgia rheumatica (PMR) and/or temporal arteritis (TA), the clinical course in four of six fatal cases was associated with malignancy. In one case the poiymyalgic symptoms were clearly associated with the recurrence of a previously operated uterine carcinoma. This case represented a paraneoplastic phenomenon and responded poorly to corticosteroid treatment. In another patient, who died of myocardial infarction one year after the onset of TA, a clinically silent brain tumour was found on autopsy. In the third patient a malignant lymphoma occurred 4 years after the diagnosis of PMR was made, and in the fourth case TA and PMR preceded the discovery of a metastasizing adenocarcinoma of unknown origin by 3 years. In the latter three cases the long interval between the onset of the poiymyalgic symptoms and the discovery of malignancy and the excellent response to steroid treatment were not consistent with a paraneoplastic mechanism of the rheumatic symptoms. The observed inc...