Cancer of Unknown Primary (CUP): genetic evidence for a novel nosological entity? A case report.

EMBO Molecular Medicine
Silvia BenvenutiPaolo M Comoglio

Abstract

Cancer of unknown primary (CUP) is an obscure disease characterized by multiple metastases in the absence of a primary tumor. No consensus has been reached whether CUPs are simply generated from cancers that cannot be detected or whether they are the manifestation of a still unknown nosological entity. Here, we report the complete expression and genetic analysis of multiple synchronous metastases harvested at warm autopsy of a patient with CUP. The expression profiles were remarkably similar and astonishingly singular. The whole exome analysis yielded a high number of mutations present in all metastases (fully shared), additional mutations (partially shared) accumulated one after another in a series, and few private mutations were unique to each metastasis. Surprisingly, the phylogenetic trajectory linking CUP metastases was atypical, depicting a common "stream", sprouting a series of linear "brooks", at variance from the extensive branched evolution observed in metastases from most cancers of known origin. The distinctive genetic and evolutionary features depicted suggest that CUP is a novel nosological entity.

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Citations

Aug 12, 2020·Expert Review of Anticancer Therapy·Elie Rassy, Nicholas Pavlidis
Jun 20, 2020·EMBO Molecular Medicine·Veronica Davalos, Manel Esteller

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Methods Mentioned

BETA
biopsy
exome sequencing

Software Mentioned

Strelka2
ClonEvol R package
SciClone
CopywriteR
CytoVison
ANNOVAR
preprocessCore package
Burrows Aligner ( BWA )
TCGAbiolinks
R

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