原發(fā)不明2023.v1-NCCN（英文版）

NCCNClinicalPracticeGuidelinesinOncologyNCCNGuidelines?)OccultPrimary(CancerofUnknownPrimary[CUP])ersionJulyVersion1.2023,07/27/2022?2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon8/6/20227:10:18AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.rydex*DavidS.Ettinger,MD/Chair?TheSidneyKimmelComprehensiveCancerCenteratJohnsHopkinsMarvarettaM.Stevenson,MD/ViceChair?DukeCancerInstituteDanielAhn,DO?MayoClinicCancerCenterSalwanAlMutar,MD,MS?UTSouthwesternSimmonsComprehensiveCancerCenterDavidBajor,MD?CaseComprehensiveCancerCenter/UniversityHospitalsSeidmanCancerCenterandClevelandClinicTaussigCancerInstituteofColoradoCancerCenterofColoradoCancerCenterSamBrondfield,MD,MA?UCSFHelenDillerFamilyComprehensiveCancerCenterJulieBykowski,MDфesComprehensiveenterScottD.Christensen,MD?UCDavisComprehensiveCancerCenterChildrensResearchChildrensResearchHospitalTheUniversityofTennesseeHealthScienceCenterKeithD.Eaton,MD,PhD?TFredHutchinsonCancerResearchCenter/SeattleCancerCenterAlliancenesPanelDisclosuresDavidGierada,MDфSitemanCancerCenteratBarnes-JewishHospitalandWashingtonUniversitySchoolofMedicineG.WeldonGilcrease,MD¤HuntsmanCancerInstituteattheUniversityofUtahAngelaJain,MD?FoxChaseCancerCenterAparnaKalyan,MD?RobertH.LurieComprehensiveCancerCenterofNorthwesternUniversityZacharyKohutek,MD,PhD§Vanderbilt-IngramCancerCenterChristinaKong,MD≠StanfordCancerInstituterrcerHospitalJohnKosteva,MD?AbramsonCancerCenterattheUniversityofPennsylvaniatoonsinronsineCancerCenterfettfettCancerCenterSarbajitMukherjee,MD,MST?¤RoswellParkComprehensiveCancerCenterawMDONealawMDighamandAnujPatel,MDighamandWomensCancerCenterBradfordPerez,MD§MoffittCancerCenterJohnPhay,MD?TheOhioStateUniversityComprehensiveCancerCenter-JamesCancerHospitalandSoloveResearchInstituteAsifRashid,MD≠TheUniversityofTexasKerryReynolds,MD?MassachusettsGeneralHospitalCancerCenterLeeRosen,MD?UCLAJonssonComprehensiveCancerCenterLeonardSaltz,MD?T?MemorialSloanKetteringCancerCenterJeffreyB.Smerage,MD,PhD??UniversityofMichiganRogelCancerCenterDaphneB.Stewart,MD,MS?CityofHopeNationalMedicalCenterMcCulloughRNBSPhDфDiagnostic/Interventionalradiology¤Gastroenterology?Hematology/HematologyoncologyTInternalmedicine?Medicaloncology≠Pathology§Radiotherapy/Radiationoncology?Surgery/Surgicaloncology*DiscussionSectionWritingCommitteeVersion1.2023,07/27/2022?2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon8/6/20227:10:18AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.rydexyPanelMembersoftheGuidelinesUpdatesPrimariesOCCdAdenocarcinomaorCarcinomaNotOtherwiseSpecifiedOCCinomaOCCforAllOccultPrimariesOCCImmunohistochemistryMarkersforUnknownPrimaryCancers(OCC-A)iplesofSystemicTherapyandSelectedSystemicTherapyRegimensforOccultPrimaries(OCC-B)nTherapyOCCClievesthatthebestmanagementforanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.FindanNCCNMemberInstitution:/home/member-institutions.ofEvidenceanddationsotherwisedNCategoriesofEvidenceandConsensus.NCCNCategoriesofPreference:Allrecommendationsareconsideredappropriate.SeeNCCNCategoriesofPreference.TheNCCNGuidelinesareastatementofevidenceandconsensusoftheauthorsregardingtheirviewsofcurrentlyacceptedapproachestotreatmentAnyclinicianseekingtoapplyorconsulttheNCCNGuidelinesisexpectedtouseindependentmedicaljudgmentinthecontextofindividualstancestodetermineanypatientscareortreatmentTheNationalComprehensiveCancerNetworkNCCNmakesnorepresentationsorwarrantiesofanykindregardingtheircontentuseorapplicationanddisclaimsanyresponsibilityfortheirapplicationoruseinanywayTheNCCNationalComprehensiveCancerNetworkAllrightsreservedTheNCCNGuidelinesandtheillustrationshereinmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.?2022.Version1.2023,07/27/2022?2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.UPDATESVersion1.2023,07/27/2022?2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon8/6/20227:10:18AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.rydexsionoftheNCCNGuidelinesforOccultPrimaryfromVersioninclude?Termsmale/femalewereremovedfromsectionswheretheywereusedforclarityofrecommendations:pMammogram(inthosewithintactbreasttissueincludinggynecomastia)pPSA(inthosewithaprostateorpost-prostatectomy)pCA-125(inthosewithauterusand/orovariespresent)pConsidergynecologiconcologistconsultifclinicallyindicated(inthosewithauterusand/orovariespresent)pTesticularultrasound,ifbeta-hCGoralpha-fetoproteinmarkerselevated(inthosewithtestes)pDisclaimerremoved:NCCNrecommendationshavebeendevelopedtobeinclusiveofindividualsofallsexualandgenderidentitiestothegreatestextentpossible.Onthispage,thetermsmaleandfemalerefertosexassignedatbirth.OCC-1?Footnotebrevised:CT/MRIimagingshouldbeperformedwithIVcontrastunlesscontraindicated.PET/CTisanalternativeinpatientswithacontraindicationtocontrastenhancement.(AlsoforpagesOCC-3throughOCC-6andOCC-11)?Footnoteerevised:Thepopulationofpatientswithmicrosatelliteinstability-high/mismatchrepairdeficientMSI-high/MMR-deficient(MSI-H/dMMR)occultprimarytumorsislow.Useimmunohistochemisty(IHC)forMMRorpolymerasechainreaction(PCR)forMSI,whicharedifferentassaysmeasuringthesamebiologicaleffect.?Footnotefrevised:Considernext-generationsequencing(NGS)inpatientsbasedonclinicopathologicfeaturesandwhereitguidestherapeuticdecision-making.Assolidtumorbiopsyispreferredbutifnotavailable,plasmacirculatingtumorDNA(ctDNA)/liquidbiopsywouldbeanacceptablealternative.(AlsopageOCC-2)OCC-6?Footnoteremoved:X-rayisrecommendedforinitialevaluation.Ifthereisconcernforspinemetastasesorpathologicfractures(eg,pain,neurologicsymptoms),MRIorcontrast-enhancedCTshouldbeusedforinitialevaluation.Whenx-rayfilmssuggestmetastasesinweight-bearingareas,furtherimagingisrecommendedfortherapeuticevaluation.(AlsoforpageOCC-11)OCC-8?ManagementBasedonWorkupFindings,followingAxillary,optionsrevised:pFemale:TreatperNCCNGuidelineforBreastCancer(inthosewithintactbreasttissueincludinggynecomastia).pMale:Axillarynodedissection(inthosewithaprostateorpost-prostatectomy),considerRTifclinicallyindicated,considersystemictherapyifclinicallyindicatedOCC-11?Footnotemrevised:Checkresultsofp16immunohistochemistry/HumanPapillomavirus(HPV)insituhybridization(ISH)andEpstein-BarrVirus(EBV)insituhybridization(ISH);positiveresultscanhelplocalizeprimarysite.OCC-B2of11?UsefulinCertainCircumstances,newregimenadded:mFOLFIRINOX.UPDATESVersion1.2023,07/27/2022?2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon8/6/20227:10:18AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.rydexsionoftheNCCNGuidelinesforOccultPrimaryfromVersionincludeOCC-B3of11?PreferredRegimenspNewoptionadded:Paclitaxelandcarboplatin,Paclitaxel80mg/m2IVDays1,8,and15,CarboplatinAUC2IVDays1,8,and15,Repeatevery4weeks.pFOLFIRIoptionrevised:Irinotecan180mg/m2IVDay1,Leucovorin400mg/m2IVinfusiontomatchdurationofirinotecaninfusionDay1,Fluorouracil400mg/m2IVbolusDay1,then,Fluorouracil1200mg/m2/dayIVcontinuousinfusionx2days(total2400mg/m2over46–48hours)continuousinfusion,Repeatevery2weekspOptionremoved:mFOLFOX6withRadiationOxaliplatin85mg/m2IVonDay1,Leucovorin400mg/m2IVonDay1,Fluorouracil400mg/m2IVPushonDay1,Fluorouracil800mg/m2IVcontinuousinfusionover24hoursdailyonDays1and2,Cycledevery14daysfor3cycleswithradiation.(AlsoforpageOCC-B7of11)OCC-B4of11?OtherRecommendedRegimensplsnnfusionalfluorouracil/leucovorinRoswellParkregimen,optionrevised:Leucovorin500mg/m2IVover2hours,Days1,8,15,22,pSimplifiedbiweeklyinfusionalFlourouracil/Leucovorin(sLV5FU2),optionsrevised:Leucovorin400mg/mIVover2hoursonDay1,followedbyfFluorouracilbolus400mg/mIVbolus,andthenFluorouracil1200mg/m/dayIVcontinuousinfusionx2days(total2400mg/mover46–48hours),continuousinfusionRepeatevery2weeks.(AlsoforpageOCC-B8of11)pWeekly,optionrevised:Leucovorin20mg/m2IVover2hoursonDay1...(AlsopageOCC-B9of11)?Footnotesremoved:pOnlyforpatientswithperformancestatusECOG0–1.pForpatientsineligibletoreceiveplatinum-basedchemotherapy.pForpatientswithpresumedGIprimarysite.pSeeNCCNGuidelinesforManagementofImmunotherapy-RelatedToxicities.pForpatientswithrecurrentoradvancedtumorsthathaveprogressedonorfollowingpriortreatmentandwhohavenosatisfactoryalternativetreatmentoptions.Note,patientswhohadreceivedpriorimmunecheckpointinhibitortherapywereexcludedfromthedostarlimab-gxlyclinicaltrial.UPDATESVersion1.2023,07/27/2022?2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon8/6/20227:10:18AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.rydexsionoftheNCCNGuidelinesforOccultPrimaryfromVersionincludeOCC-B5of11?NewpageaddedandUsefulInCertainCircumstancesregimensmovedtothispage.?FOLFIRINOX,optionsrevised:Oxaliplatin85mg/mIVDay1,Irinotecan180mg/mIVDay1,Leucovorin400mg/mIVonDay1,Fluorouracil400mg/mIVpushonDay1,Fluorouracil1200mg/mover24hoursIVcontinuousinfusionX2days(total2400mg/mover46–48hours)continuousinfusionstartingonDay1,Repeatevery2weeks?Newoptionadded:mFOLFIRINOXOxaliplatin85mg/mIVonDay1,Irinotecan150mg/mIVDay1,Leucovorin400mg/mIVonDay1,Fluorouracil1200mg/mover24hoursIVcontinuousinfusionX2days(total2400mg/mover46–48hours)startingonDay1,Repeatevery2weeks.?Newheadingadded:OnlyindMMR/MSI-HTumorspFirstoptionrevised:Pembrolizumab(onlyintumorsthataredMMR/MSI-HorhaveTMB-H[≥10mut/Mb])...pSecondoptionrevised:Dostarlimab-gxly(onlyintumorsthataredMMR/MSH-H)...?Newheadingadded:OnlyinTumorswithTMB-H(≥10mut/Mb]).pNewoptionadded:Pembrolizumab,200mgIVDay1,Repeatevery3weeks,OR,400mgIVDay1,Repeatevery6weeks.OCC-B7of11?PreferredRegimenspNewoptionadded:PaclitaxelandcarboplatinPaclitaxel80mg/m2IVDays1,8,and15,CarboplatinAUC2IVDays1,8,and15,Repeatevery4weeks.OCC-B9of11?NewpageaddedandUsefulinCertainCircumstancesregimensmovedtothispage.?Newheadingadded:OnlyIndMMR/MSI-HTumorsorTumorsWithTMB-H(≥10mut/Mb])pOptionrevised:Pembrolizumab(onlyintumorsthataredMMR/MSI-HtumorsorhaveTMB-H[≥10mut/Mb]).OCC-B10of11?Referencesupdated.OCC-B11of11?Referencesupdated.icalstainscaycategoryBdgyhasbeenmadefnicalPresentationNGuidelinesNGuidelinesorThyroidCarcinomaSeeNCCNGuidelinesforMelanomaicalstainscaycategoryBdgyhasbeenmadefnicalPresentationNGuidelinesNGuidelinesorThyroidCarcinomaSeeNCCNGuidelinesforMelanoma:CutaneousSeeNCCNGuidelinesforSoftTissueSarcomaNGuidelinesancerFurtherevaluationandAppropriatefollow-uprydexUATIONWORKUPUATIONWORKUPotsitespeciic?CompleteH&P?CompleteH&P,includingbreast,genitourinary,pelvic,andrectalexam,withattentiontoandreviewof:pPastbiopsiesormalignanciespRemovedlesionspSpontaneouslyregressinglesionspExistingimagingstudies?CBC?Electrolytes?Liverfunctiontests(LFTs)?Creatinine?Calcium?Chest/abdominal/pelvicCTbscan?Hemocculttest?Urinalysisasindicated?LDHasindicated?Clinicallydirectedendoscopy,asindicatedBiopsy:?Coreneedlebiopsy(preferred)and/orFNAwithcellblockofmostaccessiblesite?Consultpathologistforadequacyofspecimenandadditionalstudiesincluding?Tumormutationalburden(TMB)determinationbyavalidatedand/orFDA-approved?MSI/MMRtestinge?Genesequencingtopredicttissueoforiginisnotrecommended.?Next-generationsequencing(NGS)canbeconsideredafteraninitialdeterminationofThyroidcarcinomaedMelanomaedSarcomaumorGermcellumorNonmalignantdiagnosisaFormanypatientstheapparentuncertaintiessurroundingthediagnosisofaFormanypatientstheapparentuncertaintiessurroundingthediagnosisofanunknownprimarycancermayresultinsignificantpsychosocialdistressandincreaseddifficultyinacceptingtreatmentoptions.Empatheticdiscussionaboutthenaturalhistoryofthesetypesofcancerandtheirprognosis,andtheprovisionofsupportandcounselingbothbytheprimaryoncologyteamandspecializedservicesmayhelptoalleviatethisdistress.SeeNCCNGuidelinesforDistressManagement.bCT/MRIshouldbeperformedwithIVcontrastunlesscontraindicated.PET/CTisanalternativeinpatientswithacontraindicationtocontrastenhancement.eThepopulationofpatientswithmicrosatelliteinstability-high/mismatchrepair-deficient(MSI-H/dMMR)occultprimarytumorsislow.Useimmunohistochemisty(IHC)forMMRorpolymerasechainreaction(PCR)forMSI,whicharedifferentassaysmeasuringthesamebiologicaleffect.cSeeImmunohistochemistryMarkersforUnknownPrimaryCancers(OCC-A).fConsidernext-generationsequencing(NGS)inpatientsbasedonclinicopathologicfeaturesandwhereitguidestherapeuticdecision-making.Asolidtumorbiopsyispreferredbutifnotavailable,plasmacirculatingtumorDNAcSeeImmunohistochemistryMarkersforUnknownPrimaryCancers(OCC-A).Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.OCC-1Version1.2023,07/27/2022?2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon8/6/20227:10:18AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.rydexGNOSISCLINICALPRESENTATIONEpithelial;notsitespecificadenocarcinomaorcarcinomanototherwisespecifiedderNGStoidentifyrrationsfactionablerrationsf?Predominantandisolatedcervicalnodes?Supraclavicularnodes?Axillarynodesiastinum?Chest(multiplenodules)orpleuraleffusions?Peritoneal?Retroperitonealmass?Inguinalnodes?Liverneain?Multiple,includingskinSquamouscellcarcinomaetumorinicalPresentationinicalPresentationinicalPresentationinicalPresentationinicalPresentationNCCNGuidelinesforfConsidernext-generationsequencing(NGS)inpatientsbasedonclinicopathologicfeaturesandwhereitguidestherapeuticdecision-making.AsolidtumorbiopsyispreferredbutifnotavailableplasmacirculatingtumorDNA(ctDNA)/liquidbiopsywouldbeanacceptablealternative.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.OCC-2Version1.2023,07/27/2022?2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.MammograminthosewithintactbreasttissuenggynecomastiaifnondiagnosticandhologicevidenceforbreastcancerRIbandorbreastultrasoundindicatedyProstate-specificantigen(PSA)(inthosewithaprostateorpost-prostatectomy)MammograminthosewithintactbreasttissuenggynecomastiaifnondiagnosticandhologicevidenceforbreastcancerRIbandorbreastultrasoundindicatedyProstate-specificantigen(PSA)(inthosewithaprostateorpost-prostatectomy)MammograminthosewithintactbreasttissuenggynecomastiaifnondiagnosticandhologicevidenceforbreastcancerbreastMRIband/orbreastultrasoundindicatedyPSAinthosewithaprostateorpost-adenocarcinomaorcarcinomanototherwisespecifiedrydexNTATIONADDITIONALWORKUPgalnodesSeeNCCNGuidelinesforHeadandNeckCancersand/orOccultPrimaryclavicularAxillarynodes?Neck/chest/abdominal/pelvicCTb(ifnotdone)opriateimmunohistochemistryh?Endoscopy,opriateimmunohistochemistryhopriateimmunohistochemistryhNeckchestabdominalCTbopriateimmunohistochemistryhSeeManagementBasedonWorkupFindings(OCC-7)bCT/MRIshouldbeperformedwithIVcontrastunlesscontraindicated.PET/CTisanalternativeinpatientswithacontraindicationtocontrastenhancement.gSymptom-directedendoscopycanbeconsideredforindividualpatientsbasedonclinicalfindingsandimmunohistochemicalmarkers.hAnexpandedpanelofimmunohistochemicalmarkersmaybeusedasappropriate.SeeImmunohistochemistryMarkersforUnknownPrimaryCancers(OCC-A).Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.OCC-3Version1.2023,07/27/2022?2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.Mammograminthosewithintactbreasttissueincludinggynecomastia);histopathologicevidenceforbreastcancerbreastMRIbandorbreastultrasoundindicatedyPSAinthosewithaprostateorpost-prostatectomy)trasoundifbetahCGoralphafetoproteinmarkerselevatedMammograminthosewithintactbreasttissueincludinggynecomastia);histopathologicevidenceforbreastcancerbreastMRIbandorbreastultrasoundindicatedyPSAinthosewithaprostateorpost-prostatectomy)trasoundifbetahCGoralphafetoproteinmarkerselevatedewithtestes?Chest/abdominal/pelvicCTb(ifnotdone)opriateimmunohistochemistryhCA(inthosewithauterusand/orovariespresent)Considergynecologiconcologistconsultifclinicallyindicated(inthosewithauterusand/orovariespresent)Mammograminthosewithintactbreasttissueincludinggynecomastia);histopathologicevidenceforbreastcancerbreastMRIbandorbreastultrasoundindicatedyPSAinthosewithaprostateorpost-prostatectomy)?Chest/abdominal/pelvicCTb(ifnotdone)UrinecytologycystoscopyifsuspiciousopriateimmunohistochemistryhCA(inthosewithauterusand/orovariespresent)Gynecologiconcologistconsultinthosewithauterusand/orovariesMammograminthosewithintactbreasttissueincludinggynecomastia);histopathologicevidenceforbreastcancerbreastMRIbandorbreastultrasoundindicatedyPSAinthosewithaprostateorpost-prostatectomy)ementrydexodulesorotherwisespecifiedPeritoneal/AscitesITIONALWORKUPg?Chest/abdominal/pelvicCTb(ifnotdone)opriateimmunohistochemistryh?Beta-opriateimmunohistochemistryhbCT/MRIshouldbeperformedwithIVcontrastunlesscontraindicated.PET/CTisanalternativeinpatientswithacontraindicationtocontrastenhancement.gSymptom-directedendoscopycanbeconsideredforindividualpatientsbasedonclinicalfindingsandimmunohistochemicalmarkers.hAnexpandedpanelofimmunohistochemicalmarkersmaybeusedasappropriate.SeeImmunohistochemistryMarkersforUnknownPrimaryCancers(OCC-A).Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.OCC-4Version1.2023,07/27/2022?2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.CA(inthosewithauterusand/orovariespresent)Gynecologiconcologistconsultifclinicallyindicated(inthosewithauterusand/orovariespresent)MammograminthosewithintactbreasttissueincludingynecomastiaifnondiagnosticandhistopathologicevidenceCA(inthosewithauterusand/orovariespresent)Gynecologiconcologistconsultifclinicallyindicated(inthosewithauterusand/orovariespresent)Mammograminthosewithintactbreasttissueincludingynecomastiaifnondiagnosticandhistopathologicevidenceforbreastcancer,breastMRIband/orbreastultrasoundindicatedyPSAinthosewithaprostateorpost-prostatectomy)yBeta-hCG,alpha-fetoprotein,testicularultrasound(inthosewithtestes)MammograminthosewithintactbreasttissueincludinggynecomastiaifnondiagnosticandhistopathologicevidenceforstMRIbandorbreastultrasoundindicatedrydexadenocarcinomaorcarcinomanototherwisespecifiedRetroperitonealma