[Diagnostic management of inaugurable metastases]

A COMPLEX SITUATION: Carcinomas of unknown primary site (CUP) represent at least 3% of cancers in adults. This group is heterogenic and difficult to treat, the central element of which is permanent discussions between the physician and the anatomopathologist. SPECIFIC CLINICAL FORMS: The physician must rapidly identify certain entities of good prognosis or particular treatment: cervical lymph node metastases, axillary adenopathies from occult breast cancer, primary papillary peritoneal carcinomatosis, and median line syndrome. OTHER THAN IN THESE SITUATIONS: Present recommended diagnosis strategy is limited and non-invasive (histological review with immunohistochemistry, measurement of alphaFP, beta-HCG, PSA, chest X ray, mammography, tomography of abdomen and pelvis). Positron emission scintigraphy would merit further evaluation.