Open Access

Cancer of unknown primary histologically, genetically and spatially diagnosed as left ovary‑derived cancer: A case report

  • Authors:
    • Harunori Honjoh
    • Ayumi Taguchi
    • Hirofumi Rokutan
    • Ayako Mori
    • Takahiro Ando
    • Akira Nishijima
    • Satoko Eguchi
    • Yuichiro Miyamoto
    • Kenbun Sone
    • Mayuyo Uchino‑Mori
    • Yutaka Osuga
  • View Affiliations

  • Published online on: October 19, 2023     https://doi.org/10.3892/ol.2023.14109
  • Article Number: 522
  • Copyright: © Honjoh et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Cancer of unknown primary (CUP) is a heterogeneous syndrome of metastatic cancer in which the primary site cannot be determined even after a standard and comprehensive search. The present report describes a case in which the spatial distribution of the lymph node metastases contributed to the identification of the primary site. While the standard workup did not identify the primary tumor, genomic profiling analysis was useful in therapeutic management. A 68‑year‑old woman presented with a cancerous pleural effusion (adenocarcinoma). The primary site could not be identified, and the pleural effusion resolved spontaneously. After 11 months, the patient had elevated Krebs von den Lungen‑6 and cancer antigen 125 levels, and multiple enlarged lymph nodes. Pathological diagnosis based on a biopsy sample of the para‑aortic lymph nodes indicated that the tumor was a high‑grade serous carcinoma of possible gynecological organ origin. The patient underwent surgery, including hysterectomy, bisalpingo‑oophorectomy and lymph node dissection. Although there were no primary sites in the gynecological organs, marked lymphovascular invasion was found around the left ovary, suggesting a left ovary‑derived tumor. Genetic testing revealed a high loss of heterozygosity score and high tumor mutational burden (TMB). The patient received paclitaxel and carboplatin therapy followed by a poly ADP‑ribose polymerase inhibitor as regimens for ovarian cancer and achieved complete remission. The unique course of the disappearance of the effusion and the absence of tumor in the adnexa might be associated with the high immunogenicity of the tumor characterized by the high TMB. This case may provide insights into the pathogenesis of CUP.
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December-2023
Volume 26 Issue 6

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Spandidos Publications style
Honjoh H, Taguchi A, Rokutan H, Mori A, Ando T, Nishijima A, Eguchi S, Miyamoto Y, Sone K, Uchino‑Mori M, Uchino‑Mori M, et al: Cancer of unknown primary histologically, genetically and spatially diagnosed as left ovary‑derived cancer: A case report. Oncol Lett 26: 522, 2023.
APA
Honjoh, H., Taguchi, A., Rokutan, H., Mori, A., Ando, T., Nishijima, A. ... Osuga, Y. (2023). Cancer of unknown primary histologically, genetically and spatially diagnosed as left ovary‑derived cancer: A case report. Oncology Letters, 26, 522. https://doi.org/10.3892/ol.2023.14109
MLA
Honjoh, H., Taguchi, A., Rokutan, H., Mori, A., Ando, T., Nishijima, A., Eguchi, S., Miyamoto, Y., Sone, K., Uchino‑Mori, M., Osuga, Y."Cancer of unknown primary histologically, genetically and spatially diagnosed as left ovary‑derived cancer: A case report". Oncology Letters 26.6 (2023): 522.
Chicago
Honjoh, H., Taguchi, A., Rokutan, H., Mori, A., Ando, T., Nishijima, A., Eguchi, S., Miyamoto, Y., Sone, K., Uchino‑Mori, M., Osuga, Y."Cancer of unknown primary histologically, genetically and spatially diagnosed as left ovary‑derived cancer: A case report". Oncology Letters 26, no. 6 (2023): 522. https://doi.org/10.3892/ol.2023.14109