Squamous cell CUP – Unusual accumulation in women?

A cervical CUP syndrome is a histologically confirmed metastasis of a malignant tumor in which the primary remains unknown despite an intensive search for the primary. CUP syndrome is classified as prognostically favorable or unfavorable according to the clinical and histological picture. Treatment is based on the prognostic classification. The prevalence is decreasing due to modern imaging techniques. There is an increase after the 5th decade of life and in men. Four patients presented to our clinic in 2023 with an indolent cervical mass. The mean age was 65.25 . The clinical picture already indicated a possible malignancy, so staging including panendoscopy and PET-CT was performed, and two patients showed clear clinical signs of a gynecological malignancy with enlarged axillary lymph nodes. Only one patient had a history of nicotine abuse and no relevant secondary diseases. Based on the diagnostics, no primum could be confirmed in three cases. In one patient, a possible primum was found in the area of the parotid gland. The histological entity found in all 4 cases was squamous cell carcinoma. The diagnosis and treatment of CUP syndrome represents an interdisciplinary challenge. The 5-year survival rate is approx. 20-55%. The prevalence of this disease in women is a rarity and can delay the start of treatment due to the extensive diagnostics required.