UNKNOWN PRIMARY TUMOR SITES IN SPINAL METASTASIS

ABSTRACT Objective: The goal of the study was to report the prevalence of spinal metastasis with unknown primary tumor, clinical features, treatment results and patient survival. Methods: A retrospective evaluation of 103 patients with spinal metastasis and epidural compression, who underwent surgical treatment between March 2009 and August 2015. The prevalence of metastatic spinal tumor with unknown primary tumor was evaluated, as well clinical features, survival and treatment results. Results: Of 103 patients with spinal metastasis and epidural compression, seven patients (6.8%) with unknown primary tumor site were identified; five (71.4%) male and two (28.6%) female, with ages ranging from 37 to 67 years (50.7 years). The metastasis was located in the thoracic spine in six of the patients (85.7%) and in the cervical spine in one (14.3%). The mean survival time was 44.8 days. Conclusion: Spinal metastasis with unknown primary tumor was found in 6.8% of patients. The prognosis and outcomes were poor, and patients had poor survival rates. Level of evidence III; Experimental study.

Large neck metastasis with unknown primary tumor - a case report

Introduction. Metastatic head and neck carcinoma from an unknown primary tumor is defined as a metastatic disease in the neck?s lymph nodes without evidence of a primary tumor after appropriate investigation. Multiple national guidelines recommend that essential steps in diagnostic protocols involve a detailed clinical exam with radiological imaging, fine-needle aspiration (FNA) biopsy of the cervical tumor, panendoscopy with palatine and lingual tonsillectomy, immunohistochemical staining, and human papillomavirus (HPV) detection. Treatment of head and neck carcinomas of unknown primary (CUPs) origin involves surgery (neck dissection) with radiotherapy, while some authors recommend chemo-radiotherapy in cases of the advanced regional disease. Case report. A 44-year old male was referred to the tertiary medical center because of a large ulcero-infiltrative cervical mass on the right side. Examination of the head and neck and flexible nasopharyngolaryngeal endoscopy was conducted, followed by computed tomography (CT) of the head, neck, and thorax with intravenous contrast. The primary localization of the tumor was not confirmed by these diagnostic methods. Open biopsy of the neck mass confirmed histopathology diagnosis of metastatic squamous cell carcinoma. Results of panendoscopy with biopsies and bilateral tonsillectomy were negative for malignancy. Treatment included extended radical neck dissection with reconstruction and postoperative ipsilateral radiotherapy. Five years after the first surgery, the patient presented with an extensive pharyngolaryngeal tumor. Biopsy with histopathology examination confirmed the diagnosis of squamous cell carcinoma. Conclusion. A structured step-by-step diagnostic approach in identifying the primary site of the metastatic head and neck carcinoma is mandatory. Substantial advances in diagnostics and operative techniques have increased the likelihood of primary tumor identification, as well as detection of regional and systemic spread of the disease. Purpose of adherence to guidelines results in higher overall-survival and longer regional disease-free survival in these patients.

BT-09 Anhidrosis in neurohypophyseal germinoma treated with CBDCA and VP-16

Introduction: Acquired generalized anhidrosis (AGA) is the disease with non-congenital, non-segmented diffuse sweating dysfunction and is associated with neurological signs and dysautonomia except for anhidrosis. Here we have experienced 2 cases of AGA in the patient with neurohypophyseal germinoma after carboplatin (CBDCA) plus etoposide (VP-16) (CARE) therapy. Relationship of AGA to neurohypophyseal germinomas and their treatment is discussed. Cases: We experienced two young (26 y/o and 27 y/o) female neurohypophyseal germinoma cases of anhidrosis. They received CARE as chemotherapy and whole ventricular irradiation. They showed heat retention 2 to 3 years after initial treatment without recurred germinoma. Because acetylcholine sweating test was negative and skin biopsy revealed normal sweat gland structure, the diagnosis of acquired idiopathic generalized anhidrosis (AIGA), idiopathic pure sudomotor failure subtype, was initially made. After steroid pulse therapy, sweat function recovered partially and completely. Discussion: AIGA and germinoma are both rare diseases. So, the present 2 cases have similar clinical settings, that anhidrosis may not be idiopathic but secondary. Affected responsible site of anhidrosis in the present cases is thought to be acetylcholine receptor in the sweat cells. The present cases did not have any known disease with anhidrosis and did not receive any medication which cause anhidrosis written in the statement of the virtues of a medicine. Commonly used drugs in both cases are infusion solutions, CARE and related drugs, hormone stimulating test agents. Recently anhidrosis is reported in a case of cancer of unknown primary tumor site after using CBDCA and PTX. Both of the present cases are used CBDCA, which may cause anhidrosis. Conclusion: CBDCA may attributed to the occurrence of AGA based on hypothalamic vulnerability.