Große-Thie Christina, Maletzki Claudia, Junghanss Christian, Schmidt Kathie
Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock 18057, Germany.
World J Clin Cases. 2021 Aug 26;9(24):7092-7098. doi: 10.12998/wjcc.v9.i24.7092.
Cancer of unknown primary (CUP) is a histological proven malignant tumor whose origin cannot be detected despite careful examination. Most cervical lymph node metastases in CUP (80%) will originate from head and neck sites, and 15% show infiltration of squamous carcinoma cells. The survival rates of CUP are poor: The 5-year-survival rate ranges from 10% to 15%. First-line treatment recommendation for advanced, inoperable squamous cell carcinoma of head/neck (HNSCC) was cetuximab plus platinum-fluorouracil chemotherapy until recently, when checkpoint inhibitors proved clinically beneficial therapies.
Here, we report a case of a 42-year-old female patient with cervical and abdominal lymph node and distant bone metastases of an occult primary of the head and neck (squamous cell carcinoma, human papillomavirus positive). The cancer was diagnosed during pregnancy 10 years ago, and after giving birth, the patient was treated with cetuximab plus platinum-fluorouracil chemotherapy achieving complete remission (CR). CR lasted 26 mo when new metastases (abdominal lymph node, lumbar vertebral body) emerged. Both manifestations were irradiated. From then on, the patient has not received any further treatment, and her disease has remained controlled. Ten years after the initial cancer diagnosis, the patient is still alive and in good health, representing an exceptional case of HNSCC.
This case illustrates the exceptional clinical course and benefits of combined therapy approaches in advanced metastatic HNSCC with occult primary.
原发灶不明的癌症（CUP）是一种经组织学证实的恶性肿瘤，尽管经过仔细检查仍无法检测到其起源。CUP中大多数颈部淋巴结转移（80%）将起源于头颈部部位，15%表现为鳞状癌细胞浸润。CUP的生存率很低：5年生存率在10%至15%之间。直到最近，当检查点抑制剂被证明是临床上有益的治疗方法之前，晚期、无法手术的头颈部鳞状细胞癌（HNSCC）的一线治疗推荐是西妥昔单抗加铂 - 氟尿嘧啶化疗。
在此，我们报告一例42岁女性患者，患有颈部和腹部淋巴结以及头颈部隐匿原发灶（鳞状细胞癌，人乳头瘤病毒阳性）的远处骨转移。该癌症在10年前妊娠期间被诊断出来，分娩后，患者接受了西妥昔单抗加铂 - 氟尿嘧啶化疗并实现完全缓解（CR）。CR持续了26个月，之后出现了新的转移灶（腹部淋巴结、腰椎椎体）。对这两个病灶都进行了放疗。从那时起，患者未再接受任何进一步治疗，其病情一直得到控制。在最初诊断癌症10年后，患者仍然健在且身体健康，这是HNSCC的一个特殊病例。
本病例说明了晚期转移性隐匿原发灶HNSCC联合治疗方法的特殊临床过程和益处。
