Fluid biopsy for circulating tumor cells in an occult ovarian cancer patient exhibiting bilateral supraclavicular lymph node metastases: A case report

Extra-abdominal Lymph Node Metastases as the First Presentation in Ovarian and Fallopian Tube Carcinomas

Revision of ovarian and fallopian tube cancer presentation as extra-abdominal lymph nodes to understand the diagnostic challenges and prognostic features of these situations. Literature review in PubMed and Cochrane databases using the terms "ovarian cancer," "fallopian tube cancer," "extrapelvic lymph nodes," extra-abdominal lymph nodes," "distant lymph nodes," "initial presentation," "metastases," and "unusual presentation of ovarian cancer/unusual presentation of fallopian tube cancer" isolated and in conjunction. Articles in English were analyzed regarding revision's purpose, inclusion, and exclusion criteria and 65 were included in the final document. Statistical data was obtained with Microsoft Excel software analysis. Distant manifestations of ovarian cancer may occur through the lymphatic system and, less frequently, through hematogenous spread. These forms of spread may exist with almost no symptoms related to the primary cancer location and can justify distant disease at the initial presentation. Extra-abdominal lymph node involvement poses a clinical challenge for oncologists and oncologic gynecologists because it may occur with no or mild symptoms, and even in situations where no macroscopic disease is seen in the pelvic cavity. Histology and immunohistochemistry analyses together with a high level of suspicion are paramount to help in the diagnostic workup decisions and in finding a correct diagnosis when an extra-abdominal lymph node is the first manifested sign. Given its rarity and scarcity of information dispersed in a few case reports and small case series, further investigation is needed to understand the particularities of these tumors and their prognostic relevance.

Fallopian tube tumour presenting as supraclavicular lymph node metastasis

A 72-year-old woman noted a lump in her left supraclavicular fossa with no other symptoms or other signs on physical exam. A cervical biopsy indicated metastatic carcinoma. On the diagnostic workup: thoracic-abdominal-pelvic CT revealed augmented lymph nodes (LNs) in the retroperitoneum; Positron Emission Tomography-CT showed uptake in the LNs described and in two small areas in the pelvis; blood tests showed elevated CA125 and CA72.4. Another biopsy, considering a para-aortic LN, proved to be metastasis of a high-grade serous carcinoma (HGSC). Gynaecological exam and pelvic imaging were innocent. Diagnostic laparoscopy, including hysterectomy and bilateral adnexectomy, was performed and anatomopathological examination confirmed a HGSC in the fallopian tube (FT), in a tiny focus of 1.5 mm. The patient continued treatment with adjuvant chemotherapy. Literature review indicates that supraclavicular LN as first manifestation of FT carcinoma is not usual, and widespread lymphadenopathies with no macroscopic pelvic disease at diagnosis are even rarer.

Low-Grade Ovarian Serous Adenocarcinoma with Lymph Node Metastasis in Neck

Low-grade ovarian serous adenocarcinoma is rarely encountered in the neck region. The diagnosis of this rare malignancy entity in the neck is challenging for both clinicians and pathologists. A 53-year-old female with a chief complaint of a right lower neck mass that had been growing for approximately 2 weeks. The ultrasound-guided fine needle aspiration cytology favored malignancy. The positron emission tomography/computed tomography scan revealed the clustered enlarged lymph nodes with increased radioactivity uptake in the right neck level V, and strong radioactivity uptake was also displayed in the right ovarian regions. Pelvis magnetic resonance imaging displayed right adnexal complex mass supporting the ovarian cancer. An en bloc resection of the right neck lymph node was conducted. Ovarian serous adenocarcinoma with metastasis of lymph nodes in the neck was confirmed through histopathological findings. This study reviews the clinical features of low-grade ovarian serous carcinoma metastasizing to lymph nodes in neck. Although very rare, ovarian cancer with neck metastasis should be considered in the differential diagnosis of a neck mass lesion. The clinical staging would be relatively high due to the quiet entity of the cancer.

An occult urothelial carcinoma with wide multiorgan metastases and its genetic alteration profiling: Case report and literature review

RATIONALE

Urothelial carcinoma, also named transitional cell carcinoma, is the most frequent occurring malignancy in the urinary system. It mainly invades the surrounding tissues and metastasizes to distant organs in later stages.

PATIENT CONCERNS

Here, we presented an unusual case of occult urothelial carcinoma primarily manifested as a multiorgan metastatic cancer in a 59-year-old man. The patient complained of pain on the left thigh root for a month. The imaging and histopathological examination revealed multiple malignancies in lung, bone, and liver.

DIAGNOSES

The histological evaluation and the immunohistochemistry (IHC) profile of liver, lung, and bone were consistent with the diagnosis of metastases from the original urothelial cancer, while imaging examination was not able to detect a primary lesion in the urinary system.

INTERVENTIONS

Based on the mutation of STK11 M51Ifs*106 detected by next generation sequencing (NGS), we started targeted therapy with everolimus.

OUTCOMES

The patient deteriorated after 3 months of treatment and passed away.

LESSONS

In this initial report of occult urothelial carcinoma, we obtained information on genetic variations of tumor tissue which could provide important information for subsequent studies on this kind of disease.

Clinical applications of the CellSearch platform in cancer patients

The CellSearch® system (CS) enables standardized enrichment and enumeration of circulating tumor cells (CTCs) that are repeatedly assessable via non-invasive "liquid biopsy". While the association of CTCs with poor clinical outcome for cancer patients has clearly been demonstrated in numerous clinical studies, utilizing CTCs for the identification of therapeutic targets, stratification of patients for targeted therapies and uncovering mechanisms of resistance is still under investigation. Here, we comprehensively review the current benefits and drawbacks of clinical CTC analyses for patients with metastatic and non-metastatic tumors. Furthermore, the review focuses on approaches beyond CTC enumeration that aim to uncover therapeutically relevant antigens, genomic aberrations, transcriptional profiles and epigenetic alterations of CTCs at a single cell level. This characterization of CTCs may shed light on the heterogeneity and genomic landscapes of malignant tumors, an understanding of which is highly important for the development of new therapeutic strategies.

Diagnostic and Prognostic Value of Circulating Tumor Cells in Head and Neck Squamous Cell Carcinoma: a systematic review and meta-analysis

Several techniques have been developed to detect circulating tumor cells (CTC) in patients with head and neck squamous cell carcinoma (HNSCC), but their diagnostic and prognostic value are not yet fully established. A computerized retrieval of literatures was conducted without time restrictions using the electronic database in December 2014. Diagnostic accuracy variables were pooled and analyzed by the Meta-DiSc software. Engauge Digitizer and Stata software were used for pooled survival analysis. Twenty-two retrieved studies were eligible for systematic review, of which 9 conformed for the diagnostic test meta-analysis and 5 for the prognostic analysis. Subgroup analysis showed 24.6% pooled sensitivity and 100% pooled specificity of detections by using positive selection strategy, which moreover presented low heterogeneity. The presence of CTC was significantly associated with shorter disease free survival (DFS, HR 4.62, 95% CI 2.51-8.52). In conclusion, current evidence identifies the CTC detection assay as an extremely specific, but low sensitive test in HNSCC. Also, the presence of CTC indicates a worse DFS.

Cervical lymph node metastases from remote primary tumor sites

Although most malignant lymphadenopathy in the neck represent lymphomas or metastases from head and neck primary tumors, occasionally, metastatic disease from remote, usually infraclavicular, sites presents as cervical lymphadenopathy with or without an obvious primary tumor. In general, these tumors metastasize to supraclavicular lymph nodes, but occasionally may present at an isolated higher neck level. A search for the primary tumor includes information gained by histology, immunohistochemistry, and evaluation of molecular markers that may be unique to the primary tumor site. In addition, 18F-fluoro-2-deoxyglocose positron emission tomography combined with CT (FDG-PET/CT) has greatly improved the ability to detect the location of an unknown primary tumor, particularly when in a remote location. Although cervical metastatic disease from a remote primary site is often incurable, there are situations in which meaningful survival can be achieved with appropriate local treatment. Management is quite complex and requires a truly multidisciplinary approach. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2374-E2385, 2016.