Metastasis

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Author: Mikael Häggström [note 1]

Primary tumor versus metastasis

Major metastasis pathways: Main origins and sites of metastases for some common cancer types. Primary cancers are denoted by "...cancer" and their main metastasis sites are denoted by "...metastases".[1]

Indications of a metastasis rather than primary tumor are mainly:

  • Tumors that are unlikely to arise at the location at hand.
  • Tumors conforming to more likely metastasis pathways.

If a suspected malignancy is present, generally check the patient history for any history of cancer, especially for tumors in more common metastasis sites, which mainly include lung, bone, liver and/or brain. In case of such history, preferably look at the microscopy slides of the past cancer to help determining whether the current case is of the same origin, versus a primary at the current body location, versus a metastasis of yet another location. If there is no known history of cancer, still consider a metastasis of unknown primary origin, especially for suspected malignancies in lymph nodes, liver, lungs, bones, or skin.[2]

Metastasis of unknown primary

Metastases of unknown primary origin[3]
Histopathologic type
- see section below for descriptions[3]
Relative incidence among metastases of unknown primary origin[3]
Well and poorly differentiated adenocarcinomas 50%
Undifferentiated carcinoma 30%
Squamous cell carcinoma 15%
Undifferentiated neoplasms 5%
  • Memorization-worthy:[note 2] Do not diagnose a renal cell carcinoma metastasis without radiologic evidence of a renal tumor. To be a plausible primary tumor for a renal cell carcinoma metastasis, a renal tumor should be visible radiologically. In cases of suspected renal cell carcinoma but no renal imaging is available, it is reasonable to ask the ordering doctor to allow you to wait with signing out the pathology report until renal radiology has been performed.

CK7 and CK20 in carcinomas of unknown primary site (CUPs)

CK7 and CK20 can give a broad indication of the primary site. Still use more specific immunohistochemistry stains instead or in addition where applicable.

Most common CK7 and CK20 patterns in carcinomas of unknown primary site (CUPs)[4]
CK20
Positive Negative
CK7 Positive
  • Urothelial carcinoma
  • Pancreatic adenocarcinoma
  • Ovarian mucinous carcinoma
  • Bladder adenocarcinoma
  • Gastric adenocarcinoma
  • Cholangiocarcinoma
  • Breast carcinoma
  • Lung adenocarcinoma
  • Endometrial adenocarcinoma
  • Endocervical adenocarcinoma
  • Ovarian (serous) carcinoma
  • Cholangiocarcinoma
  • Small cell lung carcinoma
  • Mesothelioma
  • Thyroid carcinoma
  • Salivary gland tumours
  • Kidney (papillary)
  • Urothelial carcinoma (subset)
  • Pancreatic adenocarcinoma
  • Gastric adenocarcinoma
  • Esophageal adenocarcinoma[5]
Negative
  • Colorectal adenocarcinoma
  • Merkel cell carcinoma
  • Gastric adenocarcinoma
  • Prostate adenocarcinoma
  • Renal (clear cells)
  • Hepatocellular carcinoma
  • Adrenocortical carcinoma
  • Non-seminoma germ cell tumours
  • Mesothelioma
  • Small cell lung carcinoma
  • Gastric adenocarcinoma

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. Further information on what is memorization-worthy or not: Learning pathology

Main page

References

  1. List of included entries and references is found on main image page in Commons: Wikimedia Commons: Metastasis sites for common cancers.svg
  2. Lymph nodes, liver, lungs, bones, or skin are the main sites of cancer of unknown primary origin (CUP):
    {{cite web|url=https://www.mskcc.org/cancer-care/types/cancer-unknown-primary-origin%7Ctitle=Cancer of Unknown Primary Origin|website=Memorial Sloan Kettering Cancer Center|accessdate=20222-10-14
  3. 3.0 3.1 3.2 Collado Martín R, García Palomo A, de la Cruz Merino L, Borrega García P, Barón Duarte FJ, Spanish Society for Medical Oncology (2014). "Clinical guideline SEOM: cancer of unknown primary site. ". Clin Transl Oncol 16 (12): 1091-7. doi:10.1007/s12094-014-1244-0. PMID 25392080. PMC: 4239766. Archived from the original. . 
  4. Selves J, Long-Mira E, Mathieu MC, Rochaix P, Ilié M (2018). "Immunohistochemistry for Diagnosis of Metastatic Carcinomas of Unknown Primary Site. ". Cancers (Basel) 10 (4). doi:10.3390/cancers10040108. PMID 29621151. PMC: 5923363. Archived from the original. . 
  5. Elliot Weisenberg, M.D.. Esophagus - Carcinoma - Adenocarcinoma. Pathology Outlines. Last author update: 1 June 2013. Last staff update: 31 October 2022

Image sources