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      Metastases from Occult Breast Cancer: A Case Report of Carcinoma of Unknown Primary Syndrome

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          Carcinoma of unknown primary (CUP) syndrome occurs when metastases from an unknown primary site spread to multiple organs. Occult breast cancer (OBC) is defined as a clinically recognizable metastatic carcinoma from an undetectable primary breast tumor. It accounts for 0.3–1% of all breast cancers, often presenting with lymph node, bone, and skin metastases. Clinical and radiological examinations represent the first steps in the diagnostic algorithm for CUP syndrome from OBC. However, histological and immunohistochemical analyses, multidisciplinary team evaluation, and a multidisciplinary therapy are essential in the diagnosis and treatment of CUP syndrome from OBC. We report the case of a 52-year-old woman who underwent the removal of a parietal skin lesion. The histological and immunohistochemical analyses suggested a breast cancer origin. Clinical assessment and laboratory and radiological examinations did not locate the primary tumor. Hormone therapy was offered to the patient; however, she refused it. After 28 months, the patient reported a right cervical lump, and a total-body positron emission tomography showed dissemination of the disease to the lymph nodes and bone. A CUP syndrome from OBC was diagnosed. A multimodality approach with radiotherapy and hormone and biological therapy was started. At present, 5 years from the first presentation, the patient is asymptomatic despite the disseminated disease.

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          Most cited references 27

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          Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis

          The aim of this study was to systematically review and meta-analyze published data on the diagnostic performance of combined 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of primary tumors in patients with cancer of unknown primary (CUP). A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Methodological quality of the included studies was assessed. Reported detection rates, sensitivities and specificities were meta-analyzed. Subgroup analyses were performed if results of individual studies were heterogeneous. The 11 included studies, comprising a total sample size of 433 patients with CUP, had moderate methodological quality. Overall primary tumor detection rate, pooled sensitivity and specificity of FDG-PET/CT were 37%, 84% (95% CI 78–88%) and 84% (95% CI 78–89%), respectively. Sensitivity was heterogeneous across studies (P = 0.0001), whereas specificity was homogeneous across studies (P = 0.2114). Completeness of diagnostic workup before FDG-PET/CT, location of metastases of unknown primary, administration of CT contrast agents, type of FDG-PET/CT images evaluated and way of FDG-PET/CT review did not significantly influence diagnostic performance. In conclusion, FDG-PET/CT can be a useful method for unknown primary tumor detection. Future studies are required to prove the assumed advantage of FDG-PET/CT over FDG-PET alone and to further explore causes of heterogeneity.
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            Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

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              I. The Results of Radical Operations for the Cure of Carcinoma of the Breast.

               W. S. Halsted (1907)

                Author and article information

                Case Reports in Ophthalmology
                S. Karger AG
                September - December 2020
                28 September 2020
                : 13
                : 3
                : 1158-1163
                aBreast Unit, Humanitas Clinical and Research Center – IRCCS, Milan, Italy
                bDepartment of Biomedical Sciences, Humanitas University, Milan, Italy
                Author notes
                *Damiano Gentile, Breast Unit, Humanitas Clinical and Research Center – IRCCS, Via Manzoni 56, IT–20089 Rozzano, Milan (Italy), damiano.gentile@humanitas.it
                510001 PMC7590765 Case Rep Oncol 2020;13:1158–1163
                © 2020 The Author(s). Published by S. Karger AG, Basel

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                Figures: 2, Pages: 6
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