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At least 19 recordsLinked to original sources
PubMed2001

[Management of carcinomatous metastatic pleurisy with unknown primary neoplasm].

The primary cancer remains unknown in about 7% of all cases of metastatic carcinomatous pleurisy. Thoracoscopic pleural biopsy provide good quality histology material. The pathology examination, including immunohistochemistry using a panel of well-defined antibodies can provide the diagnosis of neoplastic pleurisy of malignant carcinomatous proliferation, and help search for differentiation and rule out an identifiable primary carcinoma. When histology does not provide a satisfactory clue to the primary cancer, frequent origins include lung cancer, breast or ovary cancer in women, prostate cancer in men, and digestive tract cancer. The possible contribution of positron emission tomography remains to be evaluated. Several chemotherapy protocols can be proposed but the beneficial effect has been difficult to assess due to the heterogeneous nature of the histological forms treated. The carboplatin-paclitaxel-etoposide protocol appears to be promising in cases with an unknown primary cancer but there has been no specific assessment of this chemotherapy schedule in a subgroups of patients with carcinomatous pleurisy with an unknown primary cancer. Better understanding of the biological profile of highly metastatic cancers should be helpful in determining more targeted therapeutic schemes.

Humans↗
PubMed2000

[Neck metastases from unknown primary neoplasms (CUP syndrome)].

Carcinoma of unknown primary (CUP-syndrome) is taken into consideration when the patient has histologically confirmed metastases but the primary focus remains unknown or it's diagnosis is delayed. Metastases of unknown origin constitute from 5% to 31% of all neck metastases. Squamous cell carcinoma and anaplastic carcinoma metastases in the neck lymphatics suggest that location of primary focus can be found in head and neck region. Diagnostic procedures applied in detection of primary foci have been described. The knowledge of lymphatic metastases spreading routes is helpful in the primary focus detection. In the material of 1348 patients treated oncologically in the years 1991-1997 in ENT Department of Karol Marcinkowski University of Medical Sciences in Poznań, 22 were diagnosed for CUP syndrome. Primary foci were not found in 7 cases. In the remaining 15 patients the primary was located in nasopharynx, palatinal tonsil, tongue, hypopharynx, testes or breast. The treatment included the radical neck dissection with consecutive irradiation and/or chemotherapy, and in the case of diagnosing the primary one applied it's radical removal or radiotherapy.

Adult↗
PubMed1990

[Progress in the diagnosis of unknown primary neoplasms].

About 5% of tumours clinically begin as unknown origin metastases involving some difficult diagnostic and therapeutic problems. In these cases the main goal is the formulation of the diagnosis as rapidly as possible because only about 10-15% of diagnosed patients are susceptible of treatment. Between 1973-1989 we observed 59 patients with unknown origin metastases. The diagnosis has been expressed in 5 patients by means of histochemical and immunohistochemical analysis, in 6 patients by means of radiologic and instrumental tests and in 3 patients spontaneously after 2-3 months.

Adenocarcinoma↗
PubMed2002

Hepatic metastases from an unknown primary neoplasm (UPN): survival, prognostic indicators and value of extensive investigations.

AIM: The objectives of this study were to identify prognostic features for patients with hepatic metastases and unknown primary neoplasms (UPN), determine the common primary tumours, assess the value of diagnostic tests in finding these tumours, and evaluate the impact of therapy and knowledge of the primary tumour on patient survival. MATERIALS AND METHODS: Eighty-eight patients with UPN and liver biopsy proven hepatic metastases over a 10-year period were reviewed (M:F, 58:30; age range 27-91 years, median 64.5 years). Histopathology, diagnostic investigations and success at identifying the primary neoplasm were recorded. In addition, in 70 patients with adenocarcinoma histology (M:F, 48:22; age range 27-91 years, median 65 years), treatment and survival data from the date of biopsy were recorded. RESULTS: The histological spectrum included adenocarcinoma in 70, neuroendocrine in four, squamous cell carcinoma in four, small cell carcinoma in four, carcinoid in two, hepatoma in one and three others. Extensive investigation identified a primary neoplasm in 16/88 patients (18%) including colorectal in six, gastric in two, lung in four, oesophageal in two, prostate in one and carcinoid in one. In the adenocarcinoma group survival data were available for 62/70 patients. Sixteen of 62 patients received active treatment with either surgery, chemotherapy, radiotherapy or a combination protocol. Forty-six of 62 patients received palliative care alone. Median survival for the adenocarcinoma group overall was 49 days. The median survival for treated patients (49 days) versus untreated patients (52 days) was not significantly different (P=0.128). Patients <65 years were more likely to receive active treatment than those >65 years (P=0.006). Age with a hazard ratio (HR) of 1.01 (P=0.178), active treatment (HR=0.65;P=0.194), knowledge of the primary neoplasm (HR=0.60;P=0.213) and male gender (HR=0.88;P=0.642) had no significant effect on survival. CONCLUSION: Although hepatic metastases are associated with poor prognosis, it is essential that a liver biopsy be performed to obtain a histological diagnosis. Adenocarcinoma metastases carry a dismal prognosis, and no prognostic factors, including knowledge of the primary tumour, are significant for patient survival. Extensive investigation is not warranted in patients with adenocarcinoma liver metastases.

Adenocarcinoma↗
PubMedDate not supplied

[Unknown primary neoplasm: a retrospective 3-year study at a service of internal medicine].

The authors review all the cases of Carcinoma of Unknown Primary Site admitted to a medical service during a 3-year period (1987-1989). These cases represented 9% of all the neoplastic diseases admitted during the aforementioned period. Most of the patients presented extensive metastatic disease. The main histologic type was adenocarcinoma. The most useful of all the ancillary exams requested for primary localization and staging purposes was the computerized axial tomography (CT). The primary localization was achieved in two cases (one while the patient was still alive, and one on autopsy). The low performance status of the patients, together with the existence of advanced metastatic disease, precluded more than palliative therapy in most of the cases. The mortality of this series was 40% (4/10), with 3 autopsies performed. The authors compare their experience with the literature available, focusing the need for a work-up based on strict diagnostic criteria based on the histology and supported by specific laboratory tests. They also underline the value of the CT scan as the most useful exam in these circumstances.

Adult↗
PubMed2004

[Neoplasms of unknown primary site].

Neoplasms of unknown primary site are tumor diseases, which are diagnosed by the pathologic studies of one of their metastases. The treatment of neoplasms of unknown primary site is not totally established, except in a few situations with specific therapeutical implications, and a better prognosis. The usual treatment of neoplasms of unknown primary site is the empirical chemotherapy with taxanes (paclitaxel or docetaxel) and platines (cisplatin or carboplatin)-based regimens, with different results in the trials.

Humans↗
PubMed1983

Hepatic arterial chemotherapy and occlusion for palliation of primary hepatocellular and unknown primary neoplasms in the liver.

Eighteen patients with malignant liver disease were treated with hepatic arterial infusion (HAI) of floxuridine (FUDR), Adriamycin (doxorubicin), and mitomycin C (FUDRAM). Twelve of the patients had primary hepatocellular carcinoma and six had metastatic liver carcinoma originating from an unknown primary site. One complete remission and seven partial remissions (greater than or equal to 50% reduction in tumor size) were observed among 12 hepatocellular cancer patients, while only one partial remission was achieved among six patients with unknown primary liver neoplasms. When arterial occlusion was added to HAI of FUDRAM, a prolongation of median survival to 14 months as opposed to six months in patients with an intact arterial tree was observed (P = 0.02). Arterial occlusion had its effect on survival particularly among patients who failed to respond to HAI of FUDRAM. Thus, among nonresponding patients, the addition of arterial occlusion resulted in a median survival of 10.5 months while median survival in those without arterial occlusion was six months (P = 0.08). With procedure-related morbidity being minimal, we conclude that arterially administered FUDRAM offers a notable palliation to patients with primary hepatocellular carcinoma. In patients with unknown primary liver neoplasms and those with hepatocellular cancer who fail HAI of FUDRAM, arterial occlusion can offer additional palliation.

Adult↗
PubMedDate not supplied

[Neoplasms with unknown primary location].

Neoplasms with unknown primary location (U.P.L.N.) represent an important chapter of oncological pathology which has not yet been completely defined regarding diagnostics, therapy and prognosis. U.P.L.N. recur in clinical practice in 0.5%-10% of cases and show equal sharing in both sexes: still mortality is high. This is in agreement with the biological behavior of U.P.L.N. which is that of a neoplastic illness, systemic from the onset and therefore immediately aggressive. Treatments commonly used only slightly alter the course of the disease. If the general state of the patients allows it, treatment must include every available therapeutical remedy (CHR, RDT, CHM) conveniently evaluated in every single case and preferably under the guidance of the apparent histotype and of the onset seat. The histotype of an U.P.L.N. sensibly affects the prognosis of the patient: there is an improvement in well differentiated and lodged forms and conversely, there is a sharp impairment with fast evolution in the less differentiated and variably metastasized forms. In our case-report, the U.P.L.N. rate has been 5.37% on 1786 cancer diagnoses from February 1980 until January 1988. In 65% of these cases, the histotype sustaining the pathology was represented by adenocarcinoma, in 21% by epidermoid carcinoma and in the remaining 14% by undifferentiated carcinoma. The clinical onset most frequently observed has involved the lymph nodes, followed by involvement of the serosa, bones, lungs and liver. Complex therapeutic treatments have not provided clear results, but the use of anthracyclines and cyclophosphamide seems promising. Finally, we suggest the use of immunomodulators (such as interferons, thymus hormone, lymphokines) in association with the classic chemotherapeutics.

Adenocarcinoma↗
PubMed1987

Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases.

Fifty-six cases of this uncommon neoplastic manifestation are presented. These cases represent 0.065% of 86,589 new cases of malignant disease seen at The Princess Margaret Hospital from 1968 to 1982. There were 29 men and 27 women. The median age at presentation was 58 years. Three major groups were identified: inguinal disease, 24 cases; unilateral inguinal plus iliac disease, 16 cases; local plus systemic disease, 16 cases. Pathologic subtypes were anaplastic, 24; squamous, 11; adenocarcinoma, nine; melanoma, nine; and others, three. Survival at 5 years for all patients was 27%. Among 40 patients who presented with inguinal and inguinal plus iliac disease, survival was 37.5% at 5 years. Initial treatment following biopsy was radiation in 35, lymph node dissection in eight, and chemotherapy in four. Excisional biopsy only was performed in nine cases. There were no treatment-related deaths. The findings observed in this study, in which radiation therapy was employed as initial management in the majority of cases, suggests that radiation therapy is a valid alternative to surgery in the management of this disease.

Adult↗
PubMedDate not supplied

[Primary neoplasm of unknown origin].

Cancers of unknown primary site constitute a heterogeneous group having in common their biological behaviour. We have analysed patients with cancer of unknown primary site admitted to University Hospital of Coimbra/Internal Medicine Service III from 1st January of 1992 to 30th June of 1998. The study included 26 patients corresponding to a prevalence of 2.5% malignant neoplasias; the median age of affected patients was 64 years old with a male-to-female ratio of 4.2:1. The most frequent histological type was well differentiated and moderately well differentiated adenocarcinoma, 46.1% of all cases. Three years global survival rate was 3.9%. The herein-reported prevalence is comparable to that found in recent literature, showing a good diagnostic skill. As expected, the prognosis was poor, revealing the disease's aggressiveness and the lack of efficient therapy in the majority of case.

Adult↗
PubMed1993

Neoplasms of unknown primary site: a clinicopathological study of autopsied patients.

BACKGROUND: Malignant neoplasms of an unknown primary site (NUPS) remain a diagnostic and therapeutic challenge in clinical practice. With this in mind, we have reviewed all autopsies performed in patients with NUPS in a single institution. PATIENTS AND METHODS: By reviewing 1656 autopsies performed on adults in our institution (1974-1990), 43 cases of NUPS were found. (NUPS was defined as histologically proven malignant tumor for which a primary site could not be found after anamnesis, complete physical examination, chest X-ray and routine chemistries.) RESULTS: There were 24 men (56%) and 19 women. Mean age was 62 years (76% of patients were aged 40-75). Clinical presentation included general deterioration (73%), digestive symptoms (58%), liver enlargement (58%) abdominal pain (56%), respiratory symptoms (45%), ascites (26%) and node enlargement (16%). Abnormalities in analysis and image tests were frequent but nonspecific. Median time from admission to death was 42 days (range, 4-135). Pathologic diagnoses at autopsy were: 23 adenocarcinomas (53%), arising from pancreas (6), biliary tree (6), lung (3), prostate (2), stomach (1), kidney (1) and unknown (4); 3 squamous carcinomas (5%) (1 renal pelvis, 1 biliary tree, 1 stomach); 5 undifferentiated carcinomas (1 lung, 4 unknown); and 12 miscellaneous tumors (including 3 lymphomas, 3 neuroendocrine tumors, 3 hepatocarcinomas, 2 mesotheliomas and 1 melanoma). There was a tendency towards a metastatic pattern different from that expected from the primary tumor. Image tests were of little usefulness in the search for the primary tumor. CONCLUSIONS: 1) Adenocarcinomas were the most frequent tumor presenting as NUPS, especially from the pancreas and biliary tree. 2) In this series, at least 11% of patients were amenable to standard systemic therapies (3 lymphomas and 2 prostatic adenocarcinomas) if a correct pathologic diagnosis could have been established when alive. 3) Presenting symptoms and metastatic pattern differed from those expected for the primary neoplasm eventually found. 4) Image tests were often misleading as regards the primary site, although they were useful to quantify the dissemination of the tumor.

Adult↗
PubMed1997

[Unknown primary cancer: revision of our experience. Preliminary study].

The unknown primary cancer is a hazardous diagnostic and limited therapeutic medical problem with too much variability. It is possible to design a standard procedure using the world-wide scientific literature, which could be able to decrease patient suffering and to avoid unnecessary sanitary costs, without diminishing survival. First of all we have conducted a retrospective descriptive study including all the patients with unknown primary neoplasms detected in our Internal Medicine service during 1994. We have met 18 cases, most of them adenocarcinoma and undifferentiated carcinoma, and hepatomegaly as clinical presentation. In 8 cases (44%) was the primary tumour site identified, mainly with CT. Only 3 (16%) patients were alive at the end of the study, with a mean survival of 5 months. The mean stay and time until diagnosis were 16.5 and 21.5 days respectively. Further studies will let us to asses the effectiveness of a theoretic diagnostic protocol.

Aged↗