Abstract: Metastatic Cancer of Unknown Primary Site (CUP) accounts for approximately 3-5% of all malignant neoplasms and is therefore one of the 10 most frequent cancer diagnoses in men. Modern imaging technology and extensive work-up with specific pathology investigations (immunohistochemistry, electron microscopy and molecular diagnosis) have resulted in some improvements in diagnosis; however, the primary site remains unknown in most patients, even on autopsy. The most prevalent sites of primary tumors origin are the lung and pancreas. CUP is diagnosed at a metastatic stage, conferring an unfavorable prognosis. The liver is one of the most common organs to be involved with metastatic disease, which arises most frequently from primary sites in the colon. A total colonoscopy is the gold standard for the evaluation of the colon. We present 64 years patient with no history of disease, which refers to the Emergency Service with right flank pain. The abdominal ultrasound revealed diffuse hepatic metastasis. The CT mentioned a suspicion of well thickening of ascending colon, but upper and lower endoscopies (with a good view of the ileocecal valve) were unremarkable, as well as other exams.
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