Table 2.
Clinical and pathologic presentations of the CUP cases
| Case | Age | Gender | Imaging finding | Pertinent history | Clinical impression | Pathologic finding | Positive IHC | Negative IHC (selected pertinent negatives are listed) | Treatment | Prognosis |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 81 | M | Multiple liver and lung masses | Smoking | Stage IV lung cancer | Large eosinophilic cell tumor | AE1/AE3, CK7 | TTF-1, Napsin A, Synaptophysin, Chromogranin, HepPar-1, Arginase | Discharged to hospice care | Lost follow up |
| 2 | 62 | F | Multiple liver masses | Rectal squamous cell carcinoma, s/p surgery and chemo-radiation | Recurrent rectal carcinoma | Blue cell tumor | AE1/AE3, CK7 | p40, p63, CK5/6, Synaptophysin, Chromogranin | Palliative chemotherapy | DOD 14 months |
| 3 | 64 | M | Multiple liver masses, abdominal and retroperitoneal lymphadenopathy | None | CUP | Blue cell tumor | CK7 | CK20, HepPar-1, Arginase, Synaptophysin, Chromogranin | Palliative care | DOD 1 months |
| 4 | 42 | M | Multiple liver masses, retroperitoneal lymphadenopathy | Childhood seminoma diagnosed at age 12, recurred at age 22 | Recurrent seminoma | Poorly differentiated adenocarcinoma | CK7 | OCT3/4, CD117, CD30, PLAP, Glypican-3, CK20, CDX2, TTF-1, GATA3 | Palliative care | DOD 5 weeks |
| 5 | 47 | M | Multiple liver, lung, and spleen masses | Smoking | CUP | Large eosinophilic cell tumor | CK7 | CK20, TTF-1, Napsin A, HepPar-1, PAX8, CDX2, MelanA | Discharged to hospice care | Lost follow up |
| 6 | 56 | F | Multiple liver and bilateral ovarian masses, intraabdominal and mesenteric nodules | Liver cirrhosis | Mesothelioma vs. ovarian carcinoma | Poorly differentiated adenocarcinoma |
CK7, Bap-1 retained |
CK20, PAX8, GATA3, ER, PR, TTF-1, WT-1 | Chemo-radiation | DOD 10 months |
| 7 | 59 | F | Multiple liver masses, multiple lytic bone lesions | Liver cirrhosis | CUP | Scant pleomorphic tumor cells | CK7 | CK20, TTF-1, Glypican 3, HepPar-1, CDX2 | Discharged to hospice care | Lost follow up |
| 8 | 77 | M | Multiple liver and lung masses, and bone lytic lesions | None | Stage IV lung cancer | Spindle cell carcinoma | CK7 | CK20, TTF-1, Napsin A, p40, CK5/6 | Scheduled for oncology appointment, lost follow up | AWD 5 weeks |
| 9 | 49 | M | Multiple lung, liver, brain masses | Smoking and COPD | CUP | Scant pleomorphic tumor cells | CK7 | Heppar-1, CK5/6, TTF-1 | Palliative care | DOD 1 week |
| 10 | 47 | M |
Unknown Imaging study performed at outside hospital |
None | Unknown | Large eosinophilic cell tumor | AE1/AE3 | HepPar-1, TTF-1, CDX2, Synaptophysin, Chromogranin | Unknown | DOD 3 years |
| 11 | 51 | M | Multiple liver and lung masses, multiple abdominal lymphadenopathy, and omentum nodules | Liver cirrhosis | CUP | Scant pleomorphic tumor cells | AE1/AE3 | CK7, CK20, HepPar1, TTF-1, Synaptophysin, Chromgranin, CD45, S100 | Palliative care | DOD 3 weeks |
| 12 | 31 | M | Multiple liver masses, large abdominal masses | None | Cholangiocarcinoma | Blue cell tumor | AE1/AE3 | SOX10, S100, Chromogranin, Synaptophysin, HepPar1, Desmin, Myogenin, CD43, CD45, Arginase,WT1, CD34, OCT3/4, CK19 | Palliative care | AWD 3 weeks |
M Male, F Female, CUP Carcinoma of unknown primary, AWD Alive with disease, DOD Die of disease, COPD chronic obstructive pulmonary disease