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same site, from an unknown primary site, although there histopathology. Although there are no clear guidelines
are reports of mixed squamous and adenocarcinomas. [7] for the management of such patients, treatment should
be multimodal, including aggressive surgical resection,
The clinical investigative approach toward CUPS patients and postoperative radiotherapy. The possible role of
is mainly directed according to the histopathology, and chemotherapy is unknown. A diligent follow-up is a
every attempt should be made to obtain a good tissue must. In the future, molecular studies may increase our
sample for detailed IHC analysis. Investigations should ability to distinguish subtypes of CUSP and treat them
involve a multi-modality approach. The role of PET scan differentially.
is yet to be established but has the potential to modify
the treatment in some patients whose tumor was localized References
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with CT. As early as 1979, it was emphasized that
the analysis of tissue samples should help to eliminate 1. Greco FA, Hainsworth JD. Introduction: Unknown primary
cancer. Semin Oncol 2009;36:6-7.
the need for undirected investigations screening for the 2. Zaren HA, Copeland EM 3rd. Inguinal node metastases.
[9]
primary site. Since then, there have been signifi cant Cancer 1978;41:919-23.
advances in the molecular analysis of tumors, and so the 3. Guarischi A, Keane TJ, Elhakim T. Metastatic inguinal nodes
incidence of CUPS has decreased. [10] from an unknown primary neoplasm. A review of 56 cases.
Cancer 1987;59:572-7.
Since CUPS in the inguinal region is rare, there is a 4. Pavlidis N, Pentheroudakis G. Cancer of unknown primary
paucity of literature on the management of such patients, site. Lancet 2012;379:1428-35.
and no clear guidelines are described. The mainstay of 5. Wallack MK, Reynolds B. Cancer to the inguinal nodes from
treatment is surgery, with complete surgical excision an unknown primary site. J Surg Oncol 1981;17:39-43.
through systematic lymph nodal dissection being 6. Massard C, Loriot Y, Fizazi K. Carcinomas of an unknown
mandatory. Aggressive surgical treatment including primary origin - diagnosis and treatment. Nat Rev Clin Oncol
vascular resection and reconstruction with grafting may 7. 2011;8:701-10.
Takeuchi T, Yasui T, Izeki M, Komune S. Adenosquamous
be required to achieve tumor-free margins, as was the carcinoma of unknown primary origin: a case report and
situation in this case. Although role of postoperative literature review. J Laryngol Otol 2015;129 Suppl 2:S91-4.
radiotherapy is not clearly defi ned, it is thought that, 8. Alberini JL, Belhocine T, Hustinx R, Daenen F, Rigo P.
in the presence of extensive nodal involvement and/or Whole-body positron emission tomography using
extranodal spread of tumor, postoperative radiotherapy fl uorodeoxyglucose in patients with metastases of unknown
should be used as it would be with any known primary primary tumours (CUP syndrome). Nucl Med Commun
2003;24:1081-6.
site with squamous cell carcinoma. A review article 9. Osteen RT, Kopf G, Wilson RE. In pursuit of the unknown
indicates that surgery with adjuvant irradiation was primary. Am J Surg 1978;135:494-7.
the preferred treatment for inguinal metastasis with the 10. Oien KA, Dennis JL. Diagnostic work-up of carcinoma of
unknown primary site. [11] unknown primary: from immunohistochemistry to molecular
profi ling. Ann Oncol 2012;23 Suppl 10:x271-7.
A diligent follow-up is required for these patients. In one 11. Pavlidis N, Briasoulis E, Hainsworth J, Greco FA. Diagnostic
case report described an occult carcinoma of the penis and therapeutic management of cancer of an unknown primary.
manifested 3 years after treatment of inguinal nodal Eur J Cancer 2003;39:1990-2005.
[12]
metastasis. According to the authors, circumcision 12. Sinha M, Katema M, Malata CM. Squamous cell carcinoma
and random biopsy of glans should be a routine of such of penis presenting as groin metastasis 3 years before the
patients. The patient in the present case was also followed primary. J Plast Reconstr Aesthet Surg 2006;59:547-9.
up clinically, radiologically, and with cystoscopy in view How to cite this article: Ray MD, Vatsal S, Kumar S. Metastatic
of the presence of transitional cell carcinoma. inguinal lymph nodes with two different histological types in a case
of carcinoma of unknown primary site. J Cancer Metastasis Treat
Carcinoma of unknown primary with inguinal 2015;1:101-3.
metastasis is a rare entity. Investigations should be Received: 21-01-2015; Accepted: 08-05-2015.
directed to identify the primary site according to Source of Support: Nil, Confl ict of Interest: None declared.

Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 2 ¦ July 15, 2015 ¦ 103