Metastatic mediastinal malignant tumors of gastrointestinal origin with occult primary lesions: a case report
Cancer of unknown primary origin (CUP), accounting for 3–5% of malignancies, poses significant diagnostic challenges because of the absence of identifiable primary lesions. While common occult primary tumors involve the lung or pancreas, gastrointestinal (GI)-originated mediastinal metastases are ex...
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| Format: | Article |
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1625668/full |
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| author | Yaxuan Liu Yaxuan Liu Liang liang Yang Wen teng Hu Rui jiang Lin Song la Bai Song la Bai Min jie Ma Min jie Ma Min jie Ma Min jie Ma Biao Han Biao Han Biao Han Biao Han |
| author_facet | Yaxuan Liu Yaxuan Liu Liang liang Yang Wen teng Hu Rui jiang Lin Song la Bai Song la Bai Min jie Ma Min jie Ma Min jie Ma Min jie Ma Biao Han Biao Han Biao Han Biao Han |
| author_sort | Yaxuan Liu |
| collection | DOAJ |
| description | Cancer of unknown primary origin (CUP), accounting for 3–5% of malignancies, poses significant diagnostic challenges because of the absence of identifiable primary lesions. While common occult primary tumors involve the lung or pancreas, gastrointestinal (GI)-originated mediastinal metastases are exceedingly rare. A 54-year-old male presented with chest tightness and dyspnea. Imaging revealed a 45.5 × 36.3 mm anterior mediastinal mass. Pathological evaluation postresection revealed metastatic moderately differentiated adenocarcinoma with immunohistochemical (IHC) features (CK20+/Villin+/CK7−/TTF-1−) suggestive of GI origin. Despite comprehensive evaluations (gastroscopy, PET-CT), no primary lesions were detected. Chronic atrophic gastritis (C2) was noted, but malignancy was excluded. This case underscores the diagnostic complexity of GI-profile mediastinal CUP and highlights limitations in conventional imaging. Molecular profiling (e.g., KRAS/NRAS/BRAF mutation) and advanced diagnostics (ctDNA analysis) are critical for accurate classification and tailored therapy. Long-term surveillance remains essential, as 12% of CUPs reveal primaries during follow-up. |
| format | Article |
| id | doaj-art-51a354b78f9b4c469c9976bb49c60708 |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-51a354b78f9b4c469c9976bb49c607082025-08-20T03:28:55ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-07-011510.3389/fonc.2025.16256681625668Metastatic mediastinal malignant tumors of gastrointestinal origin with occult primary lesions: a case reportYaxuan Liu0Yaxuan Liu1Liang liang Yang2Wen teng Hu3Rui jiang Lin4Song la Bai5Song la Bai6Min jie Ma7Min jie Ma8Min jie Ma9Min jie Ma10Biao Han11Biao Han12Biao Han13Biao Han14Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, ChinaThe First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, ChinaDepartment of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, ChinaDepartment of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, ChinaDepartment of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, ChinaDepartment of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, ChinaThe First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, ChinaDepartment of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, ChinaThe First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, ChinaThe International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, ChinaControl Center of Thoracic Surgery of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, ChinaDepartment of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, ChinaThe First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, ChinaThe International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, ChinaControl Center of Thoracic Surgery of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, ChinaCancer of unknown primary origin (CUP), accounting for 3–5% of malignancies, poses significant diagnostic challenges because of the absence of identifiable primary lesions. While common occult primary tumors involve the lung or pancreas, gastrointestinal (GI)-originated mediastinal metastases are exceedingly rare. A 54-year-old male presented with chest tightness and dyspnea. Imaging revealed a 45.5 × 36.3 mm anterior mediastinal mass. Pathological evaluation postresection revealed metastatic moderately differentiated adenocarcinoma with immunohistochemical (IHC) features (CK20+/Villin+/CK7−/TTF-1−) suggestive of GI origin. Despite comprehensive evaluations (gastroscopy, PET-CT), no primary lesions were detected. Chronic atrophic gastritis (C2) was noted, but malignancy was excluded. This case underscores the diagnostic complexity of GI-profile mediastinal CUP and highlights limitations in conventional imaging. Molecular profiling (e.g., KRAS/NRAS/BRAF mutation) and advanced diagnostics (ctDNA analysis) are critical for accurate classification and tailored therapy. Long-term surveillance remains essential, as 12% of CUPs reveal primaries during follow-up.https://www.frontiersin.org/articles/10.3389/fonc.2025.1625668/fullcancer of unknown primarymediastinal metastasisgastrointestinal immunophenotypesolitary metastasisdiagnostic biomarkersliquid biopsy |
| spellingShingle | Yaxuan Liu Yaxuan Liu Liang liang Yang Wen teng Hu Rui jiang Lin Song la Bai Song la Bai Min jie Ma Min jie Ma Min jie Ma Min jie Ma Biao Han Biao Han Biao Han Biao Han Metastatic mediastinal malignant tumors of gastrointestinal origin with occult primary lesions: a case report Frontiers in Oncology cancer of unknown primary mediastinal metastasis gastrointestinal immunophenotype solitary metastasis diagnostic biomarkers liquid biopsy |
| title | Metastatic mediastinal malignant tumors of gastrointestinal origin with occult primary lesions: a case report |
| title_full | Metastatic mediastinal malignant tumors of gastrointestinal origin with occult primary lesions: a case report |
| title_fullStr | Metastatic mediastinal malignant tumors of gastrointestinal origin with occult primary lesions: a case report |
| title_full_unstemmed | Metastatic mediastinal malignant tumors of gastrointestinal origin with occult primary lesions: a case report |
| title_short | Metastatic mediastinal malignant tumors of gastrointestinal origin with occult primary lesions: a case report |
| title_sort | metastatic mediastinal malignant tumors of gastrointestinal origin with occult primary lesions a case report |
| topic | cancer of unknown primary mediastinal metastasis gastrointestinal immunophenotype solitary metastasis diagnostic biomarkers liquid biopsy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1625668/full |
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