Carcinoma Of Unknown Origin Research Articles

Cancer-Associated Thrombosis: Trends in Clinical Features, Treatment, and Outcomes From 2001 to 2020

BackgroundDespite advances in cancer and venous thromboembolism (VTE) management, the epidemiology of cancer-associated thrombosis management over time remains unclear. ObjectivesWe analyzed data from the RIETE (Registro Informatizado de la Enfermedad Trombo Embólica) registry spanning 2001 to 2020 to investigate temporal trends in clinical characteristics and treatments for cancer-associated thrombosis. MethodsUsing multivariable survival regression, we examined temporal trends in risk-adjusted rates of symptomatic VTE recurrences, major bleeding, and death within 30 days after incident VTE. ResultsAmong the 17,271 patients with cancer-associated thrombosis, there was a progressive increase in patients presenting with pulmonary embolism (from 44% in 2001-2005 to 55% in 2016-2020; P < 0.001 for trend), lung (from 12.7% to 18.1%; P < 0.001) or pancreatic cancer (from 3.8% to 5.6%; P = 0.003), and utilization of immunotherapy (from 0% to 7.4%; P < 0.001). Conversely, there was a decline in patients with prostate cancer (from 11.7% to 6.6%; P < 0.001) or carcinoma of unknown origin (from 3.5% to 0.7%; P < 0.001). At the 30-day follow-up, a reduction was observed in the proportion of patients experiencing symptomatic VTE recurrences (from 3.1% to 1.1%; P < 0.001), major bleeding (from 3.1% to 2.2%; P = 0.004), and death (from 11.9% to 8.4%; P < 0.001). Multivariable analyses revealed a decreased risk over time for VTE recurrence (adjusted subdistribution HR [asHR]: 0.94 per year; 95% CI: 0.92-0.98), major bleeding (asHR: 0.98; 95% CI: 0.96-0.99), and death (aHR: 0.97; 95% CI: 0.96-0.98). ConclusionsIn this multicenter study of cancer patients with VTE, there was a decline in thrombotic, hemorrhagic, and fatal events from 2001 to 2020. (Registro Informatizado de la Enfermedad Trombo Embólica [RIETE]; NCT02832245)

Landscape of tumor mutation burden and correlation to clinical outcomes in 1,744 solid cancers.

2667 Background: Tumor mutation burden (TMB) has proven clinical utility and efficacy related to immune checkpoint inhibitor (ICI) treatment in different tumor types. However, limited data were available to understand the landscape and matched clinical outcomes to a pan-cancer extent. Methods: Target sequencing results, using TruSight Oncology 500, from 1,744 solid cancer between 2019 and 2021 as a part of real-world clinical practice were collected. Matched clinical and histological outcomes, including PD-L1 expression ( n= 798) and immunotherapy treatment ( n= 400), were analyzed. Results: Among the 33 different cancer types, high TMB was observed in 257 patients (14.7%) with a significantly higher incidence observed in carcinoma of unknown origin (33.3%), bladder cancer (32.3%), and small bowel cancer (30.0%). TMB was positively correlated with the degree of mutation in homologous recombination genes (HRD, 0.76) and microsatellite instability (MSI, 0.51). The predictive value of high TMB to ICI treatment seemed to be enhanced when it was combined with PD-L1 expression, showing higher response rates in the PD-L1 high group (63.3%) than in the low group (22.2%). In the patients with high TMB, both longer overall survival ( p = 0.015) and progression-free survival ( p = 0.020) were observed compared to the patients with low TMB. Conclusions: We examined the landscape of TMB in a different type of cancer using clinical-level target sequencing outcomes. High TMB seems to be a promising predictive biomarker of ICI, showing a positive correlation with alteration in other DNA damage response and repair-related genes and additive value to PD-L1, which needs to be validated through further prospective trials.

Pulmonary tumour embolism and lymphangitis carcinomatosa: a case report and review of the literature

BackgroundPulmonary tumour embolism and lymphangitis carcinomatosa are complications of malignancy that may mimic the clinical presentation of pulmonary embolism.Case presentationWe present the case of a 52-year-old male patient with acute-onset right ventricular strain and dyspnoea with elevated D-dimer and without signs of pulmonary embolism on computed tomography pulmonary angiogram (CTPA) and ventilation/perfusion scintigraphy. The patient died eleven days after initial presentation. The diagnosis of pulmonary tumour embolism and lymphangitis carcinomatosa due to carcinoma of unknown origin was made post-mortem by immunohistochemical examination.ConclusionPulmonary tumour embolism and lymphangitis carcinomaosa are complications of malignancy and potential causes of acute right ventricular strain. Radiological signs are unspecific and the clinical course usually fatal. These differential diagnoses should be considered in patients with acute right ventricular strain, dyspnoea and positive D-dimer if there are no signs of pulmonary embolism on CTPA.

SURG-06. Metastases in the pineal region: a systematic review of clinical features, treatment strategies and survival outcomes

BackgroundPineal region metastases are rare but often lead to severe neurological deficits. Surgical resection may play a therapeutic role.MethodsWe searched PubMed, EMBASE, Scopus, and Cochrane according to PRISMA guidelines. Studies reporting clinical outcomes data of patients with pineal region metastases were included. Clinical characteristics, management strategies, and survival data were reviewed.ResultsWe included 30 studies comprising 46 patients. The median age at diagnosis was 58 years (range 27–82). Lung cancer (30.4%) and carcinomas of unknown origin (15.2%) were the most frequent primary tumors. In 50% of patients, symptomatic pineal metastases preceded primary tumor diagnosis. Headache (66.7%) and confusion (45.2%) were the most common presenting symptoms. Parinaud’s syndrome (47.6%) and hydrocephalus (87%) were commonly noted. Biopsy (67.4%) was preferred over surgical resection (32.6%). The most common CSF diversion protocols were endoscopic third ventriculostomy (45%) and ventriculoperitoneal shunting (27.5%). Eleven patients received adjuvant chemotherapy and 31 underwent radiotherapy. At post-treatment follow-up, symptomatic improvement (55.2%) and hydrocephalus reduction (80%) were described. Post-treatment performance status scores were statistically superior that pre-treatment scores for patients undergoing biopsy (P<0.001) and tumor resection (P=0.007) coupled with adjuvant chemo/radiotherapy. Mean follow-up was 8 months, and median overall survival was 3 months. Only two cases (4.8%) of pineal metastases recurrence were reported, and median progression-free survival was 3 months. In patients receiving adjuvant chemo/radiotherapy, no survival differences were reported between surgery and biopsy (P=0.912), nor between gross-total and subtotal resection (P=0.220). Overall survival was neither correlated with surgical approach (P=0.157), nor with CSF diversion protocol (P=0.822).ConclusionPineal region metastases can severely impair clinical status. Biopsy or surgical resection may significantly improve symptoms and baseline performance status when combined with adjuvant chemo/radiotherapy and CSF diversion.

Proximal Type - Epithelioid Sarcoma- A Rare And Aggressive Soft Tissue Neoplasm

Abstract Introduction/Objective Epithelioid Sarcoma is a rare malignant soft tissue neoplasm that is well known for local recurrence, regional lymph node involvement, and metastasis. It accounts for less than one percent of all sarcomas. Two subtypes of epithelioid sarcoma are described: the conventional or classic subtype and the proximal subtype, with the classic type being more common than the proximal type. We present a case of proximal epithelioid sarcoma involving the inguinal region, in which the patient presented with the history of weight loss for one year and a slow- growing inguinal mass for the last few months. The biopsy was done in an outside hospital and showed carcinoma of unknown origin. Imaging also failed to reveal any clear source of this mass. Methods The mass was resected and sent to pathology, where H&amp;E staining and immunohistochemistry was done for diagnosis. Results The H&amp;E sections of the left inguinal mass showed proliferation of large epithelioid cells with a moderate amount of cytoplasm, vesicular nuclear chromatin and prominent nucleoli. Mitosis was also seen. Necrosis was not identified. Immunohistochemical staining was done and revealed that the tumor cells were immunoreactive for epithelial marker cytokeratin AE1/AE3 and showed loss of INI-1. Tumor cells were also negative for Myogenin, ERG, HMB-45, MART-1, Myo-D1, S100, and SMA. Considering the cytomorphology and immunophenotypic findings the diagnosis of epithelioid sarcoma, proximal type was made. Conclusion Epithelioid sarcoma is a malignant mesenchymal neoplasm with epithelioid cytomorphology and phenotype. Among the two types of epithelioid sarcoma, the proximal type is reported about 50% less than the classic type and is associated with aggressive behavior and worse prognosis. The classic cytomorphology and immunohistochemistry findings helped us in making the diagnosis in this case.

VANISHING PERICARDIAL EFFUSION AFTER CPR

A rare phenomenon of vanishing pericardial effusion (PCE) after CPR emphasizes the role of echo guidance for pericardiocentesis (Pc). A 64-year-old male with a recent diagnosis of carcinoma of unknown origin presented with dyspnea, and chest pain. His TTE revealed a large PCE with echocardiographic

Haemoperitoneum Due to Spontaneous Rupture of a Liver Metastasis.

Spontaneous rupture of a liver metastasis is a life-threatening complication of metastatic liver disease. Although metastatic liver lesions are much more common than primary tumours, spontaneous rupture of a liver metastasis is rare. Therapeutic decisions must take into account the extent of metastatic liver disease and the patient’s performance status. Transarterial embolization may be considered in cases of ongoing haemorrhage despite initial conservative measures. We describe a case of haemoperitoneum due to spontaneous rupture of a liver metastasis in a 72-year-old patient with carcinoma of unknown origin who responded well to conservative management.LEARNING POINTSSpontaneous rupture of a liver metastasis is a rare but potentially life-threatening complication of metastatic cancer to the liver; risk factors include subcapsular location, rapid tumour growth and tumour necrosis (spontaneous or due to chemotherapy).Unexplained fever often precedes the spontaneous rupture, probably reflecting tumour necrosis or infiltration of the liver capsule, and may raise clinical suspicion for the diagnosis.Transarterial embolization may be considered in cases of ongoing haemorrhage despite initial conservative measures.

1860P - Carcinoma of unknown origin: Deep genomic profile helps to achieve an accurate diagnosis

1860P - Carcinoma of unknown origin: Deep genomic profile helps to achieve an accurate diagnosis

28P - Clinical impact of using a deep genomic profile in carcinoma of unknown origin

28P - Clinical impact of using a deep genomic profile in carcinoma of unknown origin

A dilemma of large cell carcinoma of unknown origin – A case report of intravscular (intimal) epithelioid angiosarcoma

A dilemma of large cell carcinoma of unknown origin – A case report of intravscular (intimal) epithelioid angiosarcoma

Role of PET CT in detection of primary in carcinoma of unknown origin

Role of PET CT in detection of primary in carcinoma of unknown origin

A rare case report of an aggressive malignant spiradenoma chest wall masquerading as carcinoma of unknown origin - Course of events and review of literature

Malignant eccrine spiradenomas are exceedingly rare and aggressive tumours normally arising in long-standing benign eccrine spiradenomas. We present a case of malignant eccrine spiradenoma (MES) that was initially misdiagnosed as carcinoma of unknown origin in spite of extensive workup to look for primary and presented with a large exophytic tumour on the right side of his chest wall, which had fungated. Radiological imaging of the chest region revealed extensive involvement of the local tissues. Patient underwent wide local excision with a 1 cm margin along with right-sided axillary lymph node dissection. Histopathological findings were consistent with MES with tumour deposits in multiple lymph nodes in the axilla. Our case report shows MES is a rare and aggressive cancer, which is difficult to diagnose, highly aggressive with propensity to involve the lymph nodes. May present with local recurrence and also develop distant metastases significantly compromise the quality of life of the patient. It requires the surgeons to have a high index of suspicion for its initial diagnosis, and a multidisciplinary management with surgery, radiotherapy, and chemotherapy is required for complete treatment and needs close follow up.

Metastases from the lung presenting as a parotid lump

We report a case of a 59-year-old man who presented with a preauricular facial lump that was suspected to be a parotid malignancy based on fine needle aspiration. A chest radiograph and a computed tomogram showed a mass in the lungs and several metastases, and caused a diagnostic dilemma as to the origin of the parotid mass, which was later confirmed to be metastatic disease that had arisen from a carcinoma of unknown origin. Infraclavicular metastasis to the parotid is rare but should not be overlooked particularly in patients who present with coexisting conditions, or when cytological findings are atypical.

Metástasis cutáneas de carcinomas primarios de origen desconocido. Aporte de 3 casos y breve revisión

Metástasis cutáneas de carcinomas primarios de origen desconocido. Aporte de 3 casos y breve revisión

False Positive Radioiodinated Metaiodobenzylguanidine ((123)I-MIBG) Uptake in Undifferentiated Adrenal Malignant Tumor.

123I-Metaiodobenzylguanidine (123I-MIBG) scintigraphy is a widely used functional imaging tool with a high degree of sensitivity and specificity in diagnosis of pheochromocytoma. However, rare cases of false positive reactions have been reported. A 67-year-old male patient was admitted with epigastric pain. Abdominal computed tomography (CT) revealed a heterogeneous left adrenal mass 6 cm in diameter; following hormone testing, 123I-MIBG scintigraphy was performed to determine the presence of pheochromocytoma, which confirmed eccentric uptake by a large left adrenal gland mass. Chest CT and PET-CT confirmed metastatic lymphadenopathy; therefore, endobronchial ultrasound transbronchial needle aspiration was performed. Metastatic carcinoma of unknown origin was suspected from a lymph node biopsy, and surgical resection was performed for definitive diagnosis and correction of excess hormonal secretion. A final diagnosis of undifferentiated adrenal malignant tumor was rendered, instead of histologically malignant pheochromocytoma, despite the uptake of 123I-MIBG demonstrated by scintigraphy.

Rozsiany ziarniniak obrączkowaty u pacjenta z przerzutami raka płaskonabłonkowego do węzłów chłonnych o nieustalonym ognisku pierwotnym – opis przypadku

Rozsiany ziarniniak obrączkowaty u pacjenta z przerzutami raka płaskonabłonkowego do węzłów chłonnych o nieustalonym ognisku pierwotnym – opis przypadku

The Ability to Diagnose Intrahepatic Cholangiocarcinoma Definitively Using Novel Branched DNA-Enhanced Albumin RNA In Situ Hybridization Technology.

Intrahepatic cholangiocarcinoma (ICC) often is a diagnosis determined by exclusion. Distinguishing ICC from other metastatic adenocarcinomas based on histopathologic or immunohistochemical analysis often is difficult and requires an extensive workup. This study aimed to determine whether albumin, whose expression is restricted to the liver, has potential as a biomarker for ICC using a novel and highly sensitive RNA in situ hybridization (ISH) platform. Modified branched DNA probes were developed for albumin RNA ISH. The study evaluated 467 patient samples of primary and metastatic lesions. Of the 467 samples evaluated, 83 were ICCs, 42 were hepatocellular carcinomas (HCCs), and 332 were nonhepatic carcinomas including tumors arising from the perihilar region and bile duct, pancreas, stomach, esophagus, colon, breast, ovary, endometrium, kidney, and urinary bladder. Albumin RNA ISH was highly sensitive for cancers of liver origin, staining positive in 82 (99 %) of 83 ICCs and in 42 HCCs (100 %). Perihilar and distal bile duct carcinomas as well as carcinomas arising at other sites tested negative for albumin. Notably, 6 (22 %) of 27 intrahepatic tumors previously diagnosed as carcinomas of undetermined origin tested positive for albumin. Albumin RNA ISH is a sensitive and highly specific diagnostic tool for distinguishing ICC from metastatic adenocarcinoma to the liver or carcinoma of unknown origin. Albumin RNA ISH could replace the extensive diagnostic workup, leading to timely confirmation of the ICC diagnosis. Additionally, the assay could serve as a guide to distinguish ICC from perihilar adenocarcinoma.

Death by Subdural Hematoma with Metastatic Carcinoma of Unknown Origin: An Autopsy Case Report

Dural metastasis associated with chronic subdural hematoma is very rare in patients with malignant neoplasms; it may be difficult to distinguish malignant neo- plasms from chronic subdural hematoma. Chronic subdural hematoma is usually a late manifestation of malignant tumors, which contributes to the severity of the progno- sis. The scans obtained by using magnetic resonance imaging or computed tomogra- phy may be misleading when a subdural hematoma masks the underlying tumor. Herein, we report a case of a subdural hematoma with dural metastasis of unknown origin in a 45-year-old woman; however, the neoplasm was not detected until autopsy.

Fluoro-deoxy-glucose-(18f) Positron Emission Tomography in Diagnostic of Carcinoma of Unknown Origin

Carcinoma of unknown origin is defined as the absence of primary tumor and biopsy proved the existence of metastatic changes. The incidence is about 3% of all cancers. We present a case of a patient who underwent surgery for left breast mammography verified pathological lymphonodes on the left breast and on the left axillary region. Histopathological analysis of excised tissue showed the absence of malignant disease in the breast. A complete diagnostic evaluation also did not confirm the primary lesion. We done fluorodeoxyglucosa positron emission tomography, which had set suspicion of primary breast cancer, but biopsy and pathological reverification were not confirmed. The patient spent six cycles of chemotherapy for cancer of unknown origin. After a year and six months because of sudden right side hemiparesis were performed Computed Tomography and Magnetic Resonance imaging of the head, which indicated that it was a metastatic brain tumour. After metastasectomy, histopathological finding was finally proved to be a metastasis of breast adenocarcinomas. The patient had irradiation of the cranium, and began chemotherapy protocol for breast cancer. In this case, insufficient diagnosis did not affect in the proper therapeutic approach.

A phase I study of paclitaxel, carboplatin, and YM155 (survivin suppressor) in subjects with solid tumors.

3090 Background: To determine the maximum-tolerated dose (MTD) and to assess the safety, pharmacokinetics, and preliminary evidence of antitumor activity of YM155 (Y), a small-molecule selective survivin suppressant, administered in combination with carboplatin (C) and paclitaxel (P). Methods: Patients with advanced malignancies who had received no more than one prior chemotherapy regimen received C (AUC6) and P (200mg/m2) followed by escalating doses of Y administered as a continuous intravenous infusion (CIVI) over 72 hours in 21-day treatment cycles. Results: Twenty two patients (19 lung, 1 adenoid cystic, 1 angiosarcoma, 1 carcinoma of unknown origin) received 98 cycles of Y at six different dose levels from 3.6 to 12mg/m2 with standard doses of C and P. Treatment with Y was well tolerated, grade 3/4 toxicities consisted of grade 3 neutropenia (41%) and thrombocytopenia (14%) and grade 4 neutropenia (41%). Non hematological toxicities consisted of grade 3 hypophosphatemia (18%), hyponatremia (14%), hypokalemia (9%) and grade 4 hyponatremia (9%). Grade 3 amylase and grade 3 pneumonitis during cycle 1 were considered dose limiting at the 12mg/m2 dose. The MTD was determined as 10mg/m2 and the median steady-state concentration, clearance, volume of distribution, and terminal elimination half-life of YM155 were 16.2 ng/mL, 8.6 L/h/m2, 226 L/m2, and 17 hours, respectively. Of 16 evaluable patients, 5 (31%) achieved a partial response and 11 (69%) achieved stable disease. Conclusions: The combination of Y (10mg/m2/d 72 hours CIVI) administered with C and P every 3 weeks exhibited a favorable safety profile. A phase II trial as first line therapy in patients with stage IV non small cell lung cancer is ongoing.