cancer of unknown primary: Ancillary testing of cytologic and small biopsy specimens in the era of targeted therapy

Cancer Cytopathology
Morgan L Cowan, Christopher J VandenBussche

Abstract

Initial evaluation of patients presenting with a suspected malignancy without a clear clinical or radiologic impression of a primary site (so-called cancer of unknown primary, or CUP) frequently includes fine needle aspiration (FNA) to both establish a diagnosis and procure tissue for additional studies. Careful management of limited specimen material is especially important in the modern era, when molecular studies may take precedence over a more definitive tissue diagnosis. This review summarizes our practice habits when encountering a CUP. Broadly, key morphologic patterns in context of patient history and clinical-radiologic impression should guide the selection of a limited panel of IPOX stains to establish first a broad lineage. Subsequently 1-2 site-specific markers may be used to confirm the diagnosis. In difficult cases, it is helpful to convey the situation to the treating physicians, who may prefer to prioritize molecular testing over pursuit of a more definitive diagnosis. Prudent choice of immunoperoxidase (IPOX) studies, based on both key cytomorphologic criteria and continued communications with the clinical team regarding their needs for treatment planning, is critical in CUP cases.

References

Oct 1, 1970·Cancer·F F Holmes, T L Fouts
Nov 1, 1983·Histopathology·J D DaviesS L Mera
Nov 1, 1995·Urology·F AbbasM S Soloway
Feb 14, 1995·Proceedings of the National Academy of Sciences of the United States of America·W L GeraldM Ladanyi
Apr 1, 1997·Cytopathology : Official Journal of the British Society for Clinical Cytology·R S RanaA Das
Aug 1, 1997·The American Journal of Surgical Pathology·D M DorfmanJ K Chan
Sep 12, 2000·Applied Immunohistochemistry & Molecular Morphology : AIMM·P A BejaranoP W Biddinger
May 16, 2002·Histopathology·P G Chu, L M Weiss
Jun 18, 2002·Nature·Helen DaviesP Andrew Futreal
May 29, 2004·Cytopathology : Official Journal of the British Society for Clinical Cytology·I Srebotnik KirbisM Us Krasovec
Oct 16, 2004·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Christopher A FrenchJonathan A Fletcher
Jan 11, 2005·Endocrine Pathology·Lori A EricksonRicardo V Lloyd
Aug 4, 2006·International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society·J E KwonN H Cho
Dec 6, 2006·American Journal of Clinical Pathology·Rohit BhargavaDavid J Dabbs
Jan 27, 2007·The American Journal of Surgical Pathology·Jefferson TerryTorsten O Nielsen
May 26, 2007·Endocrine Pathology·Hironobu SasanoTakuya Moriya
Jul 27, 2007·The Journal of Molecular Diagnostics : JMD·Frederic G Barr, Richard B Womer
Mar 26, 2008·Nature Biotechnology·Nitzan RosenfeldIris Barshack
Jun 24, 2008·Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc·Allen M Gown
Aug 30, 2008·The American Journal of Surgical Pathology·Daisuke NonakaRobert A Soslow
Apr 1, 2009·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Federico A MonzonGlenda G Anderson
Apr 30, 2010·The Oncologist·F Anthony GrecoJohn D Hainsworth
May 5, 2010·Pathology·Hillary Ross, Pedram Argani
Jul 1, 2010·The American Journal of Surgical Pathology·Bora GurelAngelo M De Marzo
Oct 5, 2010·Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc·Ankur R SangoiReetesh K Pai
Feb 15, 2011·Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc·Ayhan OzcanLuan D Truong
Mar 27, 2012·The American Journal of Surgical Pathology·Akihiko YoshidaHitoshi Tsuda
Mar 31, 2012·Archives of Pathology & Laboratory Medicine·Steven S ShenAntonio Lopez-Beltran
Dec 1, 2012·Archives of Pathology & Laboratory Medicine·Ayhan OzcanLuan D Truong
Aug 3, 2013·Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc·Rashmi Kanagal-ShamannaKeyur P Patel

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Citations

May 26, 2021·Cytopathology : Official Journal of the British Society for Clinical Cytology·Yonca KanberManon Auger

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