ISSN:1082-9784    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Metastatic carcinoma of unknown primary location contributes to approximately 4% of all diagnosed carcinomas. Some metastatic carcinomas have distinctive histologic features that allow for their site determination (e.g., colonic adenocarcinoma, bronchioloalveolar cell carcinoma), though the often the features that are not distinctive enough to determine the site of origin. In addition, a histopathological distinction of primary and secondary tumors may also complicate the diagnosis. Pathologists are now frequently asked to determine the primary site for metastatic carcinomas of unknown origin using adjunctive techniques, such as immunohistochemistry and even molecular alterations. The importance of judicious attention to subtle morphological features usually provides highly valuable clues to the site of the tumor, which may substantially narrow the diagnostic possibilities. The purpose of this article is to present an algorithmic approach to morphologic classification of carcinomas of unknown primary site. Emphasis is placed on the cytomorphologic features of the malignancy, with consideration to the patient’s age, anatomic distribution of disease, and histochemical studies.

ISSN:1082-9784    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The pathologic work-up of patients with metestatic carcinoma of unknown primary can be a diagnostic challenge. Immunohistochemistry often plays a pivotal role in determining the cell lineage as well as the primary site of the malignancy. A variety of cells lineage, site specific associated antibodies and differential cytokeratins are now available as part of the armamentarium of the pathologist for the work-up of these cases. An algorithmic approach is recommended as well as the importance of interpreting the immunohistochemical results in the context of the clinical and other conventional morphologic parameters in order to establish a correct diagnosis to guide appropriate management and assess prognosis.

ISSN:1082-9784    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A positive malignant effusion may be the first indication of an unsuspected cancer. In the diagnostic work-up of a malignant effusion, it is important to consider the site, sex, and age of the patient. The low-power cytologic pattern and the high-power cytomorphologic features of the malignant cells in the effusion specimen can often suggest the primary site. In addition, since adenocarcinoma is the most common histologic type of malignancy in serous effusion, ancillary studies such as immunohistochemistry and/or electron microscopy can be of value. The clinicopathologic approach, including the use of ancillary studies can often determine the primary site of the malignancy in patients who lack a prior documented history of cancer.

ISSN:1082-9784    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Fine needle aspiration cytology is highly accurate in the diagnosis of metastatic disease. In addition to establishing a diagnosis of metastatic malignancy, pathologists are increasingly asked to determine a possible primary site. Although a previous history of malignancy and characteristic cytomorphologic and immunocytochemical features are helpful in characterizing certain tumors, many metastatic malignancies lack a specific cytologic or immunocytochemical profile. This task can also be especially challenging if there is no history of malignancy, previous pathology is not available for review, or there is an unpredictable pattern of metastasis, potentially leading to a misdiagnosis of metastasis as a primary neoplasm. This article reviews the patterns of metastasis involving common (lymph nodes, bone, lung, liver, adrenal glands, salivary glands) and unusual (breast, thyroid, pancreas, kidney, small bones, eye, spleen) sites and the most likely primaries to spread to these organs. Familiarity with the variable patterns of metastasis in conjunction with cytologic features and selected ancillary studies will facilitate an accurate diagnosis.

ISSN:1082-9784    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Metastatic carcinomas of unknown origin comprise 10% to 15% of new referrals to oncology clinics. Although the cost of attempting to determine the site of origin by using immunohistochemical tests may be as high as $2000 per patient, this cost is still remarkably lower than the cost associated with the clinical evaluation. True cost effectiveness studies of the pathologic evaluation of carcinomas of unknown origin using immunohistochemistry have yet to be performed.

ISSN:1082-9784    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Although metastatic cancer of unknown primary origin (CUP) accounts for but a small proportion of cancer diagnoses, perhaps no other oncologic disease presents as great a challenge to clinicians. It is generally defined as a biopsy-confirmed malignancy in which the primary site remains unidentified after a rigorous but limited initial clinical and radiographic evaluation. CUP represents a heterogenous group of tumors with varied clinical presentations. At the time of diagnosis, the most critical element for optimal patient management is close collaboration and communication between medical and surgical oncologists, radiologists, and pathologists so that adequate tissue samples are obtained for comprehensive pathologic analysis. In a small but important percentage of patients, thorough pathologic review establishes an alternate diagnosis (such as lymphoma, melanoma, germ cell tumor, or neuroendocrine tumor) and a therapeutic strategy can be recommended. Also, certain clinicopathologic presentations have been recognized as favorable subsets in which specific treatment has considerable benefit and prognosis is better. These include abdominal carcinomatosis and axillary node involvement in women, predominant bone metastases in men, isolated cervical or inguinal adenopathy, and midline or retroperitoneal poorly differentiated carcinoma. Unfortunately, approximately 60% of patients diagnosed with CUP have well or moderately differentiated adenocarcinoma, which does not fit in one of these favorable subgroups. For these patients, systemic multi-agent chemotherapy is only of modest value with median survival around 1 year. Optimization of palliative and supportive care is important.

ISSN:1082-9784    

出版商:OVID    

年代:2001

数据来源: OVID