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The presence of anti-CV2 autoantibodies correlates with the existence of a paraneoplastic neurological syndrome. Their detection should lead to a search for an occult cancer. Although less frequent than anti-Hu autoantibodies, anti-CV2 autoantibodies seem to occur in patients with similar clinical pictures and tumors to those with anti-Hu anti-bodies. Furthermore, the detection of anti-CV2 autoantibodies is a good tool for predicting the presence of an occult cancer (frequently a SCLC) in anti-Hu-negative patients and with a clinical presentation suggestive of a paraneoplastic neurological syndrome.

This Update summarizes studies published in 2015 that the authors consider highly relevant to the practice of hematology/oncology.

We report a case of a large condyloma on the upper side of the penis that exhibited a high FDG uptake on PET/CT images, mimicking urine contamination. The patient was a 30-year-old, HIV-infected homosexual man, and his CD4 cell count was 163/μL. FDG PET/CT imaging was performed for a survey of occult cancer. A whole-body FDG PET/CT examination showed an intense FDG uptake on the upper side of the penis. The CT portion confirmed that the lesion was not urine contamination but a tumor with a cauliflower-like shape. The tumor was excised and a histopathological examination revealed a condyloma.

Background: Idiopathic venous thrombosis (IVT) is associated with occult malignancy in 10% of patients. The Trousseau study investigated whether extensive screening using abdominal and chest computed tomography (CT) scans and mammography in women would decrease mortality, compared with limited screening. Here, the costs and test characteristics of these screening strategies are presented, including true-and false-positive findings, sensitivity and specificity. Methods: All investigations performed because of a suspicion of malignancy in the limited or extensive screening groups were collected. Costs were calculated using Dutch healthcare tariffs. Results: A total of 342 and 288 patients with IVT were included in the extensive and the limited screening group, respectively. The prevalences of malignancy and mortality were comparable between these two groups, as were the abnormal findings during routine screening. In 30% of the extensively screened patients, the CT scans or mammography showed abnormalities necessitating further diagnostic work-up; this yielded six malignancies and resulted in a positive predictive value of 6.6%, sensitivity of 33% and specificity of 70%. Mean costs per patient were (sic) 165.17 for the routine and (sic) 530.92 for the extensive screening. Conclusion: Screening using CT scans and mammography results in extra costs due to the high percentage of false-positive findings for which a further diagnostic work-up is indicated

Bronchoscopic brachytherapy is a new technique presently being investigated for the treatment of cancer involving the tracheobronchial tree.This paper reports on the potential application of bronchoscopic brachytherapy to the local treatment of cancer of the respiratory tract.Bronchoscopic brachytherapy was performed on 8 patients with roentgenographically occult lung cancer after biopsies proved malignant lesions of the trachea and bronchus in each case. These patients came to the National Cancer Center Hospital during the period from September 1992 to December 1992.Among these 8 cases of malignant lesions of the trachea and bronchus, 5 malignant lesions of the bronchus were diagnosed by bronchoscopic ultrasonography prior to the bronchoscopic brachytherapy, and these 5 patients have completed at least three courses of this therapy carried out by means of a videobronchoscope.Among the 8 cases of malignant lesions of the trachea and bronchus, complete remission was obtained in 7 cases.Of the 8 patients, the death of one patient was caused by amyotrophic lateral sclerosis, while the remaining 7 patients have survived for 13-15 months (14.1 months on average) to date, without showing recurrence or metastasis.As for the complications involved in this treatment, only a light degree of excessive secretions was observed, and there was no abcess formation in any of the cases.

The occurrence of neoplasms in patients with idiopathic deep vein thrombosis (DVT) may result in a significant reduction in survival rates. The aim of our study was to assess the use of chest X-rays (CXRs) as a screening method of intrathoracic neoplasms in patients who with idiopathic DVT. In observational, cross-sectional study, the medical records of 99 patients with idiopathic DVT, who were submitted to CXR (during the hospital stay or within 30 days after discharge), were investigated. Of these patients, 15.1% had images suggestive of thoracic neoplasias (single or multiple pulmonary nodules and mediastinal widening). Neoplasms were diagnosed in 4 patients in the follow-up with CXR. The CXR is an option of early screening for thoracic neoplasms and other nonmalignant diseases in patients with idiopathic DVT.

To describe a case of squamous cell carcinoma (SCC) arising in vulvovaginal lichen planus (LP) and to highlight difficulties in occult cancer surveillance in the setting of severe vaginal stenosis.A 67-year-old woman with long-standing systemic and vulvovaginal LP presented with multifocal vulvar SCC. Four months after radical vulvectomy and bilateral groin node dissection for stage IB carcinomas, she presented with stage III vaginal SCC arising in an obliterated vagina.Multifocal, multicentric carcinomas may arise in the vulva and stenosed vagina in women with LP.

The epidemiological features of occult papillary thyroid carcinoma (OPTC) at autopsy have not previously been reported in Turkish people. This study provides data on the prevalence of OPTC in people from the Marmara region in Turkey. The study includes thyroid glands from 93 male and 15 female cadavers between 18 and 80 years of age. The thyroid glands were removed, fixed and sectioned at 2-mm intervals. The sections were stained with hematoxylin and eosin, and were examined by a single pathologist. A total of 108 thyroid glands were examined. Macroscopic lesions were found in 36 (33.3%) glands (95% confidence interval = 24-42). OPTC was found in four (3.7%) cases (95% confidence interval = 1.0-7.5). It was concluded that in the Turkish people from the Marmara region, the prevalence of OPTC found at autopsy was relatively low. No age or sex predilection was detected. European Journal of Cancer Prevention 20:308-312.

In contrast to the established relation between known cancer and subsequent venous thromboembolism, the question of whether an association exists between venous thrombosis and the risk of subsequent overt cancer has remained without a convincing answer until 1992. A recent publication has provided a firm demonstration of this connection. Although this study has demonstrated a highly significant association between idiopathic vein thrombosis and subsequent overt malignant disease, firm recommendations for an extensive screening of cancer in all such patients cannot be made on the basis of these results.

The paraneoplastic neurologic diseases are a set of brain degenerations that develop in the setting of occult cancer. These disorders arise when common cancers express brain proteins, triggering an anti-tumor immune response and tumor immunity. Studies of the nature of these brain-cancer proteins has revealed a new world of neuron-specific RNA binding proteins whose functions may be co-opted by tumor cells. The interest in their function has spawned the development of new methods and strategies to understand RNA-protein regulation in living tissues. These approaches, and the new biology they reveal, are discussed here.

Summary. Background: Patients with a first episode of idiopathic venous thromboembolism (IVTE) have an estimated 10% incidence of cancer within 12 months after diagnosis. However, the utility of screening for cancer in this population is controversial. Methods: In this prospective concurrently controlled cohort study, limited and extensive cancer screening strategies were compared. All 630 patients underwent baseline screening consisting of history, physical examination, basic laboratory tests and chest X-ray. In the extensive screening group abdominal and chest CT scan and mammography were added. Outcomes were incidence and curability of cancer, and cancer-related and overall mortality. Results: In 12 of the 342 (3.5%) patients in the extensive screening group malignancy was diagnosed at baseline compared with 2.4% (seven of 288 patients) in the limited screening group. Extensive screening detected six additional cancers (2.0%; 95% CI, 0.74–4.3), of which three were potentially curable. During a median 2.5 years of follow-up, cancer was diagnosed in 3.7% and 5.0% in the extensive and limited screening groups, respectively. In the extensive screening group 26 patients (7.6%) died compared with 24 (8.3%) in the limited screening group; adjusted hazard ratio 1.22 (95% CI, 0.69–2.22). Of these deaths 17 (5.0%) in the extensive screening group and 8 (2.8%) in the limited screening group were cancer related; adjusted hazard ratio 1.79 (95% CI, 0.74–4.35). Conclusions: The low yield of extensive screening and lack of survival benefit do not support routine screening for cancer with abdominal and chest CT scan and mammography in patients with a first episode of IVTE.

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Soft tissue metastases are an uncommon presenting feature for primary solid tumours. This case highlights a rare presentation in which a soft tissue mass is the first clinical manifestation of a widespread disseminated malignancy of the esophagus. A 73-year-old woman presented with a soft swelling in the left upper quadrant of the abdomen arising from the anterior abdominal wall, suspicious of liposarcoma. Core biopsies revealed squamous carcinoma. Immunohistochemistry suggested the most likely diagnosis was that of metastatic carcinoma with a number of potential primary sites. Computed tomography scanning showed widespread metastatic disease, including lung, liver, kidney, omentum, subcutaneous and intramuscular lesions. The distal esophagus was noted to be circumferentially thickened. Finally, upper gastrointestinal endoscopy revealed carcinoma of the esophagus. The patient remains well awaiting esophageal stenting and palliative chemotherapy. In conclusion, it is important to be able to distinguish the origin of a soft-tissue swelling as the management will depend significantly on the histological type. Soft-tissue metastases are rarely encountered as a presenting sign of an occult cancer. Primary cancers that most commonly metastasise to soft tissues include those arising within the lung, colon and kidney. The most frequent histological diagnosis is adenocarcinoma. This case demonstrates the utility of biopsy in the investigation of soft tissue masses when the clinical presentation is unusual.

Background The PROLONG study showed that D-dimer (D-d) testing could help tailor the duration of anticoagulation after idiopathic venous thromboembolism (VTE). In this report the initial 18 month study follow-up was extended for 1 year. Materials and Methods D-d was measured 1 month after anticoagulation withdrawal for a first episode of idiopathic VTE. Patients with a normal D-d did not resume anticoagulation, while patients with an abnormal D-d were randomized to either resume or not resume treatment. The primary outcome was the composite of recurrent VTE and major bleeding. Secondary end-points were cardiovascular events, newly diagnosed cancers and deaths. Results D-d was abnormal in 222/608 (36.5%) patients. Average follow-up was 2.55 years. Twenty-eight events occurred in the 121 patients who stopped anticoagulation (23.1%, 9.6% person-years) and five in the 101 patients who resumed anticoagulation (5.0%, 2.0% person-years, adjusted hazard ratio-HR = 3.76; P = 0.008). Recurrence rate was higher in patients with abnormal D-d who stopped anticoagulation than in patients with normal D-d (51 events in 386 patients −13.2%; 5% person-years; adjusted HR 1.70; P = 0.045). The adjusted HR ratio associated with normal D-d versus abnormal D-d in patients who resumed anticoagulation was 2.7 (P = 0.042). An abnormal D-d was associated with a non significant higher risk of cardiovascular events and newly diagnosed cancers vs normal D-d. Conclusions Patients with an abnormal D-d at 1 month after withdrawal of VKA have a significant risk of recurrence over a 2.55 year follow-up and they benefit from resuming anticoagulation.

Cancer produces a hypercoagulable state, which might lead to thrombosis, and on contrary, unprovoked venous thromboembolism might be the manifestation of an occult cancer. In this pilot case-control study, we assessed the risk of gynecological malignant diseases related to the presence of the factor V Leiden and prothrombin G20210A polymorphisms. Fifty-two women underwent an operation for gynecological malignancy and were enrolled in the study. Women who underwent an operation for gynecological nonmalignant disease in the same days of cases were considered as controls. The presence of factor V Leiden and prothrombin G20210A was assessed in case and control groups. In all, 7 out of 52 cases were carriers of the 2 polymorphisms compared with 20 out of 198 controls (odds ratio = 1.3; 95% confidence interval, 0.6-3.0). The results were also similar when the risk was considered separately for the site of cancer. As for advanced and metastatic malignancies, the odds ratios were 2.3 (95% confidence interval, 0.9-6.0) and 3.3 (95% confidence interval, 1.0-11), respectively, compared to noncancer patients. When these 2 groups were compared to nonadvanced cancer group, the odds ratios for carriers of polymorphisms were 2.7 (95%confidence interval, 0.7-11.0) and 3.9 (95%confidence interval, 0.8-18.6) for advanced cancer and metastatic malignancies, respectively. Women with factor V Leiden or prothrombin G20210A polymorphisms who developed gynecological malignancy might present with a higher stage of cancer at the time of surgery. Larger case-control studies in similar cohort of patients are needed to confirm these findings.

PURPOSE OF REVIEW Although usually developing in advanced stages of the disease, venous thromboembolism may also appear before the cancer has become symptomatic and may lead to an earlier diagnosis of cancer. One clinical implication of a high risk of occult cancer in patients with acute venous thromboembolism could be an extensive diagnostic workup at the time of presentation. RECENT FINDINGS The prevalence of occult cancer is between 2.2% and 12% within the first 2 years after the venous thromboembolism. This variation in reported incidence likely reflects the variation in the intensity of cancer surveillance in each study. Although extensive screening in venous thromboembolism patients may result in early identification of hidden cancer, it is unknown whether the prognosis of the clinical course of the malignancy can be favourably influenced. SUMMARY Early discovery of occult cancer should improve the potential for cure, not merely advance the date of diagnosis. The absence of demonstrated benefit, as well as the potential for actual harm caused by the use of hazardous invasive diagnostic tests, has led to the recommendation not to use extensive screening procedures, unless indicated by clinical circumstances.

Recurrent deep venous thrombosis despite well conducted anticoagulant treatment is an uncommon, but possible, event. It has been hypothesized that overt hyperthyroidism may increase thromboembolic risk. We present the case of an elderly man with a recurrent episode of deep venous thrombosis during optimal oral vitamin K antagonist treatment, associated with a new diagnosis of overt hyperthyroidism, with no evidence of occult cancer and normal levels of antiphosholipid antibodies.

Source Citation Carrier M, Lazo-Langner A, Shivakumar S, et al; SOME Investigators. Screening for occult cancer in unprovoked venous thromboembolism. N Engl J Med. 2015;373:697-704. 26095467

Lancet Oncology, The - In Press.Proof corrected by the author Available online since lundi 29 juin 2015

Computed tomography (CT) of the abdomen and pelvis to look for undiagnosed cancer in people with unprovoked venous thromboembolism is unnecessary, a Canadian study has found, after this screening approach detected a very low rate of occult cancers.1 Unprovoked venous thromboembolism can be an early sign of cancer, and previous studies have shown that as many as 10% of patients who have a blood clot with no apparent cause get a cancer diagnosis in the subsequent year. One …

The association between cancer and thrombosis is well recognized. What is not known, however, is the exact relationship between these two common medical conditions. Although the development of venous thromboembolism (VTE) in a patient with known cancer is the most common presentation, in some patients, VTE may precede the diagnosis of malignancy by many months. The variation in clinical presentation is likely due to the heterogeneous biology of different tumor types and also reflects the limitations of detection or available diagnostic methods. Accumulating evidence now suggests that critical oncogenic events may also trigger activation of the coagulation cascade, leading to a prothrombotic environment that not only manifests as venous thromboembolic disease but also promotes the growth and progression of the malignancy. This chapter will review the evidence for screening for occult malignancy in patients presenting with unprovoked or idiopathic thrombosis, briefly outline the known biological relationships between malignancy and thrombosis, and summarize the clinical data on the potential anticancer effects of low molecular weight heparins (LMWHs).

Objective: The aim of the study was to evaluate the usefulness of multidetector row helical computed tomography (MD-CT) in assessing the local extent of breast cancer. Methods: Seventy-five breast cancer patients were examined using MD-CT with scanning performed in the supine position at 1-mm collimation. The extent of the breast tumors determined using CT was compared with that based on histopathologic mapping with continuous 5-mm slices. Results: The CT evaluation of the maximum diameter of the extent of breast cancer was much better correlated with the histopathologic diagnosis (correlation coefficient = 0.90) than the pre-CT diagnosis (correlation coefficient = 0.46). Computed tomography correctly detected mammographically and clinically occult cancer other than the index lesion in 14 of 15 patients. The sensitivity, specificity, and accuracy in the diagnosis of the additional lesions were 93.3%, 98.3%, and 97.3%, respectively. Because the images were obtained in the supine position, they were useful for surgical planning. Conclusion: The extent of breast cancer can be determined accurately using MD-CT.

Positron-emission tomography has become an important tool for evaluating tumors, detecting occult cancer, and staging and restaging tumors. This review includes a slideshow with scans from 10 patients with common cancers.

Sir, The recent report on thrombotic thrombocytopenic purpura (TTP) after transfusion of ABO incompatible blood is very interesting.[1] Solak et al. hypothesized that the TTP might be due to “transfusion of ABO incompatible blood” or “open cardiac surgery.”[1] Solak et al. also noted that “TTP secondary to ABO incompatible blood transfusion has never been reported in the literature until date.”[1] What the exact mechanism in the present case is still a myth and the data on confounding morbidity (such as occult cancer) in the present case is not well presented. In fact, it is no doubt that ABO incompatibility can induce TTP. The previous reports on TTP after ABO mismatched liver and renal transplantations are good example.[2,3] Hence, the cases of ABO blood transfusion should be no doubt for the pathogenesis of TTP.

Aim The aim of this study was to report the incidence of occult cancer in reduction mammaplasty (RM) specimens. Methods A retrospective study of 314 women who underwent RM from February 1996 to August 2001. Results Occult carcinomas were detected in three patients, in two of which the lesions were invasive. Atypical ductal or lobular hyperplasia was found in five cases and other carcinoma risk lesions in four patients. Other benign changes were identified in totally 133 patients. Conclusion Incidental carcinomas will occasionally be found in RM procedures.

We report a case of a 41-year-old woman who was diagnosed as having the syndrome of inappropriate secretion of ADH (SIADH). There was no evidence of any disorders of the central nervous system, lung diseases, or drugs causing SIADH. Positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) was performed and indicated a tumor of the uterine cervix. After resection of the tumor, both serum sodium level and serum osmolarity were normalized concomitantly with a decrease in serum ADH level. This is the first case report suggesting the usefulness of a FDG-PET scan to detect an occult cancer responsible for SIADH. It seems plausible that FDG-PET may be helpful in the diagnosis of other ectopic hormone-producing tumors such as ectopic ACTH-producing tumors that cause Cushing's syndrome.

Venous thrombosis as an initial manifestation of an underlying malignancy is rare but well known. In fact, the index of suspicion is so high that spontaneous venous thrombosis in a patient warrants screening for an occult cancer. Bilateral internal jugular venous thrombosis is rarer among the sites of idiopathic venous thromboembolism. Besides carrying risk for death due to pulmonary embolism, as a spontaneous occurrence, it strongly points to underlying malignancy when other causes have been ruled out. JMS 2012;15(1):72-73.

In a CMAJ practice article, Schattner[1][1] provides guidance regarding when to test for thrombophilia and when to screen for occult cancer in patients with unprovoked venous thromboembolism (VTE). This issue is important, because unprovoked VTE is common (about 20 000 cases a year in Canada),[2][2

The relationship between an idiopathic deep vein thrombosis and a cancer is well established. It is not clear yet whether all patients with an idiopathic deep vein thrombosis should be thoroughly investigated for an occult cancer or only some. As a matter of fact, once a physician is faced with a patient who has an idiopathic deep vein thrombosis, three approaches are possible, mainly: 1) a wait and see approach; 2) a limited investigation; and 3) an extensive or invasive investigation. No sure criteria for the selection of the patients who should be extensively investigated are available. Suggestions have been made in this regard. Negative family or personal history for thrombosis, advanced age, deep vein thrombosis of upper limbs, existence of silent deep vein thrombosis in contralateral leg, tendency to relapse and/or to migrate, constitutional symptoms, or smoking may represent important clues that may justify an extensive study. This patient-oriented approach is mainly based on the experience of the caring physician.

Rheumatic disorders associated with cancer include a variety of conditions, most of which have no features distinguishing them from idiopathic rheumatic disorders. It is generally held that an extensive search for occult malignancy in most rheumatic syndromes is not recommended unless the case is accompanied by specific findings suggestive of malignancy. Within the past year information has accumulated on the role of long-standing rheumatic disorders as premalignant conditions and the role of autoantibodies as screening tests for occult cancer. The present article discusses cancer-associated rheumatic syndromes, calls attention to aspects that may suggest the presence of a hidden cancer, and examines the role of laboratory tests as clues of a possible neoplastic etiology of those syndromes.

The association between venous thromboembolism and cancer has been widely documented and the main factor responsible for cancer-induced venous thromboembolism is considered mostly linked to a hypercoagulation state induced by the cancer itself. There is no consensus on investigative strategies for occult cancer in a patient with a thrombophilic condition. We report a patient who manifested an isolated episode of pulmonary embolism without specific evident sources of venous thromboembolism. The routine clinical and laboratory work-up to detect an occult cancer did not reveal any malignancy. A history of duodenal ulcer in association with a recent slight alteration in bowel habits led us to perform an esophagogastroduodenoscopy which was negative for malignancy, and a barium enema followed by colonoscopy, which revealed the presence of a tumor limited to the large intestine. An unexplained clinically evident hypercoagulation state, even in the presence of mild clinical symptoms, needs more thorough diagnostic strategies when simple methods of screening for occult cancer are negative.

About 3 % of all cancer patients suffer from cancer of unknown primary origin. These patients present with metastatic disease for which a primary site cannot be detected at the time of diagnosis. Sophisticated diagnostic techniques and operational procedures have failed to improve the diagnostic efficacy in this group of patients. Consequently, a limited diagnostic procedure with basic laboratory tests and imaging studies is sufficient for the diagnosis of this syndrome. The use of immunohistochemistry, os well as serum tumor markers of high specificity that may help to identify other tumors, is highly suggested. Although the prognosis for the majority of these patients still remains poor, several subsets of favorable outcome to treatment have been recognized. Nevertheless, promising in vitro data and new drugs on trials, paralleled with a better knowledge of the underlying pathogenetic molecular mechanisms, offer a more optimistic look to the future therapeutic management of these patients. 2 3 142 152