These results suggested that poorly differentiated carcinomas of unknown primary site are responsive to chemotherapy and even chemotherapy curable. A subset of this group of patients probably represent histologically (and serologically) atypical germ cell tumors. As such, patients with metastatic poorly differentiated carcinoma should be investigated for a primary site. Serum HCG and AFP should be measured. Patients with a dominant pulmonary or mediastinal mass should have fiberoptic bronchoscopy. All patients with poorly differentiated carcinomas by light microscopy should have investigations with immuno-phenotyping, immunoperoxidase staining, and electron microscopy to further characterize the tumor. buy flovent inhaler
Emerging information on specific chromosomal abnormalities associated with germ cell tumors and other malignancies may soon add tumor cytogenetic analysis to the list of procedures useful in identifying pp^-tially curable malignancies arising from an unknown primary site.
Patients with poorly differentiated carcinomas and a dominant mass in the mediastinum, retroperito-neum, or lymph nodes should receive a trial of cisplatin and etoposide-based chemotherapy. Such therapy should be applied even if electronmicroscopy identifies adenocarcinoma elements in the biopsy specimen since some of these patients do obtain durable remissions.
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