Metastatic Undifferentiated Carcinoma Research Articles

Successful treatment of metastatic thymic carcinoma with cisplatin, vinblastine, bleomycin, and etoposide chemotherapy

Thymic carcinomas are rare malignant neoplasms of the thymic epithelium that are distinguished from the malignant thymomas by the presence of cytologic atypia. Thymic carcinomas may metastasize outside of the thorax and are associated with a very poor prognosis. Complete responses of thymic carcinoma to chemotherapy alone have not been reported. A 21-year-old man with metastatic undifferentiated carcinoma of probable thymic origin is presented who achieved a pathologic complete response with cisplatin, vinblastine, and bleomycin chemotherapy. Additional consolidative chemotherapy with cisplatin and etoposide was administered. The patient remains disease-free 5 years after diagnosis. Cisplatin, vinblastine, and bleomycin chemotherapy appears to have significant activity against thymic carcinoma.

Combined chemotherapy for recurrent and metastatic nasopharyngeal carcinoma.

Thirty-two patients (24 males, 8 females; median age 54 yrs) with recurrent and/or metastatic undifferentiated carcinoma of the nasopharyngeal type were treated with chemotherapy. Remissions were observed in 17 of 32 (53.2%) with 5 complete (CR) (15.6%) and 12 partial responses (PR) (37.6%). A combination of cisplatin and 5-fluorouracil was the most effective regimen (CR + PR = 83.3%). Objective responses. (CR + PR) were 47% (CR = 11.7%) in schemes without cisplatin and 60% (CR = 20%) in cisplatin-based combinations. The median overall duration of response was 7.2 months. The median overall survival time was 10.3 months: 15.1 months for responders and 5.2 for non-responders. No important toxicity was observed.

Differential diagnosis of metastatic undifferentiated carcinoma.

Differential diagnosis of metastatic undifferentiated carcinoma.

Alteration of tumour cell arrangement related to connective tissue stroma in metastatic brain tumours. Histological and immunohistochemical studies of 68 autopsy cases

Tumour cell arrangements of a variety of 68 tumours metastatic to brain parenchyma and leptomeninges were compared histologically and immunohistochemically with those of the primary tumours in regard to their connective tissue stroma. In the brain parenchyma, more than 90% of 31 metastatic differentiated adenocarcinomas from various organs changed in cell arrangement from a tubular to a papillary pattern, in which tumour cells lined the increased perivascular connective tissue, rich in both type III collagen and fibronectin, the typical constituents of interstitial type extracellular matrices. Twelve (39%) and 3 of 31 cases were rearranged in a partially or completely tubular pattern respectively, within the metastatic nodules. Most of these neoplastic tubules were surrounded by diffusely proliferating connective tissue. Metastatic growth of carcinoma cells in the absence of supporting connective tissue in the nervous tissue was rare. A similar result was obtained for differentiated squamous cell carcinoma. In contrast, metastatic undifferentiated carcinoma and tumours with some neuro-ectodermal characteristics showed a sheet-like arrangement without pronounced connective tissue proliferation, similar to that of the primary tumours. In the leptomeninges, differentiated carcinoma cells were arranged in a tubular or a squamoid pattern and were frequently accompanied by marked stromal response. These results indicate that differentiated carcinomas require connective tissue stroma for metastatic growth, and that tumour cell arrangement in the brain varies depending upon the amount and distribution of proliferating connective tissue stroma. In undifferentiated carcinomas and tumours with neuro-ectodermal characteristics lacking stromal dependency, the tumor cell arrangement remains unchanged. The degree of stromal response to metastatic tumours in the brain parenchyma is related to the degree of epithelial differentiation.

Metastatic Adeno or Undifferentiated Carcinoma from an Unknown Primary Site Natural History and Guidelines for Identification of Treatable Subsets

Two hundred and eighty-six patients presenting with metastatic adenocarcinoma or undifferentiated carcinoma whose primary site was not identified by clinical history, physical examination and chest radiograph have been studied. Median survival from presentation was 22 weeks. Factors independently predicting improved survival were lymph node presentations, good performance status and body weight loss of less than 10 per cent. In 88 (31 per cent) patients the primary tumour site was subsequently identified, in 58 (20 per cent) during life. Lung cancer was the most frequently identified primary tumour, and in only 32 (11 per cent) of the patients was a 'treatable' primary tumour (i.e. germ cell, breast, ovarian, prostate, thyroid cancer or lymphoma) identified. Among the treatable primary tumours were those in eight out of 16 female patients presenting with axillary metastases who were subsequently shown to have primary breast cancer and four of 13 females presenting with ascites who were found to have primary ovarian cancer. Prostatic cancer was confirmed in five out of 13 men with raised serum acid phosphatase. Of 22 patients with elevated serum alphafoetoprotein (AFP) or beta-human chorionic gonadotrophin levels (beta HCG) 18 had some features of the 'atypical teratoma syndrome'. Of the total of 32 patients with treatable tumour types, 29 (90 per cent) were identified during life. Median survival for patients with treatable tumour types identified during life was 104 weeks, compared with 22 weeks for the group as a whole. Retrospective immunocytochemical staining of the original biopsy showed that prostatic specific antigen and antibodies to beta HCG and AFP were diagnostically useful, but a series of organ site non-specific markers of histogenesis or cellular differentiation (carcinoembryonic antigen, secretory component for IgA, peanut lectin binding, epithelial membrane antigen and keratin) showed no significant correlations with identified primary sites, responsiveness to empirical chemotherapy or survival. Metastatic undifferentiated carcinoma or adenocarcinoma from an unknown primary site represents 6.5 per cent of all referrals to the medical oncology unit, Royal Prince Alfred Hospital, Sydney. We offer guidelines for the rapid identification of the limited number of primary sites for which effective and specific forms of systemic treatment are available.

Malignant lymphoepithelial lesion of the salivary gland

Eight cases of malignant lymphoepithelial lesion (MLEL) of major salivary glands, seven of which occurred in Southern Chinese patients, are reported. All but two of the patients were older than 40 years of age; there were five male and three female patients. The parotid and submandibular glands were the sites of origin in equal numbers of cases. Six patients had elevated titers of serum IgA against Epstein-Barr virus capsid antigen. Seven remained well after surgery and local radiation therapy, and one died of miliary tuberculosis without evidence of residual neoplasm. Histologically, MLELs were characterized by syncytial clumps of large cells with vesicular nuclei and prominent nucleoli, admixed with abundant small lymphocytes and plasma cells. Two features not emphasized previously in the literature were the presence of reactive histiocytes in some epithelial islands, producing a starry sky pattern, and perineural invasion, which was identified in four cases. The tumor cells showed strong immunostaining for cytokeratin. The literature concerning this rare tumor is reviewed, and the differential diagnosis between MLEL and benign lymphoepithelial lesion, metastatic undifferentiated carcinoma, and malignant lymphoma is discussed.

Small Cell Carcinoma of the Lung Presenting as Bilateral Hilar Adenopathy

A patient in whom a presumptive diagnosis of sarcoidosis was made on the basis of nonspecific symptoms and BHA on chest roentgenogram is described. At necropsy the BHA was found to be due to a metastatic small cell undifferentiated carcinoma of the lung. This tumor is a previously unrecognized cause of BHA.

Prognostic features of thyroid cancerA long-term followup of 68 cases

Sixty-eight cases of thyroid cancer were followed for 10 to 38 years after diagnosis. A minimum followup period of 10 years was necessary because of the long natural history of low-grade thyroid carcinoma. The prognosis of the disease was evaluated with regard to several parameters: age, sex, histologic appearance of the tumor, extent of disease, and treatment. The best prognosis was found in women less than 40 years of age with papillary carcinoma in whom there was neither extrathyroid extension nor metastasis and who were treated by surgery alone. Extrathyroidal cancer in the neck treated by radical neck dissection had a 100% survival rate at 15 years postdiagnosis. The poorest prognosis was in male patients over 60 years of age with metastatic undifferentiated carcinoma.

Prognostic features of thyroid cancer. A long-term followup of 68 cases.

Sixty-eight cases of thyroid cancer were followed for 10 to 38 years after diagnosis. A minimum followup period of 10 years was necessary because of the long natural history of low-grade thyroid carcinoma. The prognosis of the disease was evaluated with regard to several parameters: age, sex, histologic appearance of the tumor, extent of disease, and treatment. The best prognosis was found in women less than 40 years of age with papillary carcinoma in whom there was neither extrathyroid extension nor metastasis and who were treated by surgery alone. Extrathyroidal cancer in the neck treated by radical neck dissection had a 100% survival rate at 15 years postdiagnosis. The poorest prognosis was in male patients over 60 years of age with metastatic undifferentiated carcinoma.