Use of novel genomic sequencing to characterise carcinoma of unknown primary (CUP) in patient with axillary lymphadenopathy.

IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL
Ian Robertson, Kulsum Shaikh, Edwin Gandia, Daniel Desmond
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引用次数: 0

Abstract

Carcinoma of unknown primary (CUP) comprises 2-5% of cancer diagnoses worldwide, with a prevalence that has modestly declined with increased availability of advanced diagnostic tools such as next-generation sequencing (NGS). This case presentation illustrates the possibilities and gaps that remain with improving diagnostic capabilities in identifying and effectively treating CUP. This is the case of a rapidly enlarging right axillary mass without a primary tumour site and histological evaluation demonstrating a poorly differentiated neoplasm. Tumour of origin testing using a clinically validated RNA-sequencing-based machine learning classifier unexpectedly suggested greatest probability of metastatic melanoma with lesser likelihood of fibrosarcoma. Subsequent clinical behaviour and lack of response to chemoimmunotherapy conflicted with NGS results, with a multidisciplinary team ultimately agreeing on final diagnosis of aggressive soft tissue sarcoma, specifically malignant peripheral nerve sheath tumour. The patient had a complete clinical response after forequarter amputation and a sarcoma-based chemotherapy regimen. This case highlights both the potential and current shortcomings of NGS and predictive tumour of origin analytic tools in helping with characterisation and categorisation of CUP. There is a need for improvement and optimisation of these diagnostic modalities, but they offer another option to improve historically poor outcomes in CUP.

使用新的基因组测序特征不明原发癌(CUP)患者腋窝淋巴结病。
未知原发癌(CUP)占全球癌症诊断的2-5%,随着下一代测序(NGS)等先进诊断工具的可用性增加,患病率略有下降。本病例说明了在识别和有效治疗CUP方面提高诊断能力的可能性和差距。右腋窝肿块迅速增大,无原发肿瘤,组织学检查显示为低分化肿瘤。使用临床验证的基于rna测序的机器学习分类器进行肿瘤起源测试,出乎意料地显示转移性黑色素瘤的可能性最大,纤维肉瘤的可能性较小。随后的临床行为和对化学免疫治疗缺乏反应与NGS结果相冲突,多学科团队最终同意最终诊断为侵袭性软组织肉瘤,特别是恶性周围神经鞘肿瘤。患者在前肢截肢和基于肉瘤的化疗方案后有完全的临床反应。该病例强调了NGS和预测肿瘤起源分析工具在帮助表征和分类CUP方面的潜力和当前的缺点。需要改进和优化这些诊断方式,但它们提供了另一种选择,以改善CUP的历史不良预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Case Reports
BMJ Case Reports Medicine-Medicine (all)
CiteScore
1.40
自引率
0.00%
发文量
1588
期刊介绍: BMJ Case Reports is an important educational resource offering a high volume of cases in all disciplines so that healthcare professionals, researchers and others can easily find clinically important information on common and rare conditions. All articles are peer reviewed and copy edited before publication. BMJ Case Reports is not an edition or supplement of the BMJ.
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