Poorly differentiated epithelial metastasis - Forum

Dottore

Poorly differentiated epithelial metastasis - Ärzteforum

Post#1 »

I would appreciate your opinion about this case: 70 yo white female, obese, admitted to medicine because of 2 cm left supraclavear mass.Asymptomatic. Surgery consulted for excisional biopsy, path report: poorly differentiated epithelial metastasis, most likely adenoca. No other node palpable except 1 cm left axillary (medicine did needle perc biopsy:same pathology).Work up done by medicine:past med history neg, CEA normal, chemistry normal, ENT+ bronchoscopy and biopsies:negative for malignancy,chest x ray normal, neck US:normal thyroid,no masses, abd US:normal except gallstones (asimptomatic), mammogram and breast exam:normal, barium enema:normal except sigmoid diverticulosis, gyn exam + US normal including ovaries: I did gastroscopy yesterday (one already done by other surgeon negative):no evidence of malignancy, did multiple biopsies, waiting for path results.What would you do to find the primary ? CT ? laparoscopy? Any treatment at this point? chemo? What would you tell to pt and family about prognosis?


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Surgeon

Re: Poorly differentiated epithelial metastasis - Ärzteforum

Post#2 »

If this were the only problem, and if the lymph node were at a
higher level, I would have considered radical neck dissection, followed
by irradiation therapy. However, that the lymph node is supraclav, and
the presence of an axillary node that is positive, makes the situation
different.

<1 cm left axillary (medicine did needle perc biopsy:same
pathology).>
This is probably the most important clue. The breast is the most
likely source.

<mammogram and breast exam:normal>
Classic presentation of PCU (Primary Cancer Unknown) case. The
patient is obese, and you need the highest quality of mammography,
including the best compression and, if needed, magnification views. If
you still cannot detect the primary in the breast, consider MRI of the
breast (You'll find some references at the end of this mail). Also I
recommend CT of the chest to have better look at the lungs and
mediastinum.

<What would you tell to pt and family about prognosis?>
Hard to give definite conclusions at this time. This cancer is not a
benign one, and it showed its aggressiveness by the way it presented and
by the degree of maturity (differentiation) shown on the pathology
slides. I will hold on giving any exact prognostic numeric values till
we find out more about its origin.

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