Occult Primary Pulmonary Adenocarcinoma Presenting With Multistation Nodal Disease: A Case Report
- 1Radiation Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
Abstract
Occult primary lung cancer is an uncommon presentation in which metastatic disease is histologically and immunophenotypically compatible with a pulmonary origin despite the absence of a detectable lung lesion on CT or fluorodeoxyglucose PET/CT. We report a 55-year-old man who presented with a clinically suspicious left supraclavicular lymph node and an Eastern Cooperative Oncology Group (ECOG) performance status of 1. Excisional lymph node biopsy demonstrated metastatic moderately differentiated adenocarcinoma with glandular, trabecular, and cribriform architecture and mucin production. The tumor showed diffuse strong expression of cytokeratin 7 and thyroid transcription factor 1, whereas cytokeratin 20, CDX2, GATA3, P504S, and cytokeratin 19 were not expressed, supporting a pulmonary origin. Baseline imaging demonstrated hypermetabolic cervical, bilateral supraclavicular, left axillary, and diffuse mediastinal lymphadenopathy without a detectable pulmonary primary or definite visceral or osseous metastases. Epidermal growth factor receptor testing was negative, anaplastic lymphoma kinase expression was absent, and the programmed death-ligand 1 tumor proportion score was below 1%. The patient received six cycles of cisplatin 80 mg/m² and paclitaxel 200 mg/m² intravenously on day 1 of a 21-day cycle. Marked nodal regression after three cycles prompted three additional cycles. At the end of six cycles, imaging showed only small residual nodes, no emerging lung primary, and no new metastatic sites. The patient remained in good general condition with a performance status of 1; documented toxicities were cisplatin-related hypoacusis and grade 1 lower-limb sensory neuropathy attributed to paclitaxel. Maintenance therapy was discussed, but the patient opted for surveillance; subsequent follow-up imaging demonstrated a sustained response without disease progression. This case illustrates the value of integrated histopathology, immunohistochemistry, molecular testing, and serial imaging in diagnosing and managing pulmonary adenocarcinoma with an occult primary site.
Related
- A Fatal Case of Pulmonary Tumor Thrombotic Microangiopathy Originating From Primary Bladder Adenocarcinoma
- Case Report: Cerebellopontine angle metastatic adenocarcinoma with high-grade fetal morphology and no identifiable pulmonary primary on initial CT
- P099 More than meets the lung: MALT lymphoma presenting with pulmonary nodules and consolidation in primary Sjögren’s syndrome
- Gastric Adenocarcinoma Mimicking Foveolar-type Presenting with a Whitish Elevation
- Leptomeningeal metastasis of lung adenocarcinoma presenting as cauda equina syndrome: a case report and literature review
BibTeX
@article{slimani2026occult,
title = {{Occult Primary Pulmonary Adenocarcinoma Presenting With Multistation Nodal Disease: A Case Report}},
author = {Oussama Slimani and Soumiya Samba and Mohammed Bentourqi and Ahmed BenSghier and Soufiane Berhili and Mohamed Moukhlissi and Loubna Mezouar},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117246},
url = {https://europepmc.org/article/PMC/PMC13722471},
note = {CC BY},
}
RIS
TY - JOUR
TI - Occult Primary Pulmonary Adenocarcinoma Presenting With Multistation Nodal Disease: A Case Report
AU - Oussama Slimani
AU - Soumiya Samba
AU - Mohammed Bentourqi
AU - Ahmed BenSghier
AU - Soufiane Berhili
AU - Mohamed Moukhlissi
AU - Loubna Mezouar
PY - 2026
DA - 2026/09/30
JO - Cureus
DO - 10.7759/cureus.117246
UR - https://europepmc.org/article/PMC/PMC13722471
AB - Occult primary lung cancer is an uncommon presentation in which metastatic disease is histologically and immunophenotypically compatible with a pulmonary origin despite the absence of a detectable lung lesion on CT or fluorodeoxyglucose PET/CT. We report a 55-year-old man who presented with a clinically suspicious left supraclavicular lymph node and an Eastern Cooperative Oncology Group (ECOG) performance status of 1. Excisional lymph node biopsy demonstrated metastatic moderately differentiated adenocarcinoma with glandular, trabecular, and cribriform architecture and mucin production. The tumor showed diffuse strong expression of cytokeratin 7 and thyroid transcription factor 1, whereas cytokeratin 20, CDX2, GATA3, P504S, and cytokeratin 19 were not expressed, supporting a pulmonary origin. Baseline imaging demonstrated hypermetabolic cervical, bilateral supraclavicular, left axillary, and diffuse mediastinal lymphadenopathy without a detectable pulmonary primary or definite visceral or osseous metastases. Epidermal growth factor receptor testing was negative, anaplastic lymphoma kinase expression was absent, and the programmed death-ligand 1 tumor proportion score was below 1%. The patient received six cycles of cisplatin 80 mg/m² and paclitaxel 200 mg/m² intravenously on day 1 of a 21-day cycle. Marked nodal regression after three cycles prompted three additional cycles. At the end of six cycles, imaging showed only small residual nodes, no emerging lung primary, and no new metastatic sites. The patient remained in good general condition with a performance status of 1; documented toxicities were cisplatin-related hypoacusis and grade 1 lower-limb sensory neuropathy attributed to paclitaxel. Maintenance therapy was discussed, but the patient opted for surveillance; subsequent follow-up imaging demonstrated a sustained response without disease progression. This case illustrates the value of integrated histopathology, immunohistochemistry, molecular testing, and serial imaging in diagnosing and managing pulmonary adenocarcinoma with an occult primary site.
SN - 2168-8184
ER -