1/11. thyrotoxicosis in a male patient associated with excess human chorionic gonadotropin production by germ cell tumor.We report a case of a man with thyrotoxicosis due to excess production of human chorionic gonadotropin (hCG) by metastatic choriocarcinoma, followed by alterations of his thyroid function tests by nonthyroidal illness. All reported cases of thyrotoxicosis due to high hCG levels in male patients are reviewed. patients with this syndrome usually have widespread choriocarcinoma and relatively few symptoms of thyrotoxicosis. Typically, if the patient survives the metastatic germ cell tumor, the thyrotoxicosis resolves as the hCG levels decrease after chemotherapy directed at the choriocarcinoma. Only rarely are specific antithyroid medications required. The hCG molecule directly stimulates the thyroid gland, and these patients appear to have in the serum a predominance of acidic variants of hCG with greater intrinsic thyroid-stimulating activity than the hCG secreted during a normal pregnancy. In general, these patients have a poor prognosis due to the usually widespread nature of the germ cell tumor at the time of diagnosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/11. Rare solitary metastasis to subcutaneous tissue from choriocarcinoma of testis.A rare case of solitary metastasis to subcutaneous tissue from choriocarcinoma of the testis which was predominantly seminoma is reported. The propensity for vascular route of metastasis of this tumor type producing the patient's clinical picture is presented. The human beta chorionic gonadotropin tumor marker elevation to 4,200 units preoperatively fell to normal two weeks postoperatively, suggesting a solitary metastatic site with total tumor extirpation. Nevertheless, it seemed prudent to give chemotherapy because the nature of the metastatic route suggested other microscopic sites of metastasis. The prognosis of this highly malignant neoplasm, while poorest of the array of testis tumors, has improved dramatically with the advent of effective chemotherapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/11. iodine-131 MIBG scintigraphy of neuroendocrine tumors other than pheochromocytoma and neuroblastoma.Metaiodobenzylguanidine (MIBG) locates most pheochromocytomas and neuroblastomas. The tracer is concentrated in intracellular storage vesicles by an active process. Many other neuroendocrine tumors of the amine precursor uptake and decarboxylation (APUD) series have hormonal storage vesicles and, thus, the potential to take up [131I]MIBG. A variety of neuroendocrine tumors in 57 patients were studied 1, 2, and 3 days after 0.5 mCi [131I]MIBG. Views from skull to pelvis were obtained. Results of MIBG scans were compared with all available imaging modalities (including plain radiography, liver scan, ultrasound, computed tomography, and angiography) and surgical exploration. The neuroendocrine nature of the tumor was determined by histology, immunohistochemistry, electron microscopy, and the assay of appropriate biogenic amines and peptide hormones. Results were (positive/total cases): carcinoids (four of ten), nonsecreting paragangliomas (three of three), sporadic medullary carcinomas of the thyroid (MCT) (one of five), familial MCT (one of 26), chemodectomas (two of five), oat cell carcinomas (zero of four), choriocarcinoma (one of one), atypical schwannoma (with storage granules) (one of one), Merkel cell skin cancer (one of one), islet cell carcinoma (zero of one). We conclude that a wide range of neuroendocrine tumors show [131I]MIBG uptake; tumors other than pheochromocytomas and neuroblastomas are less often seen scintigraphically, but in certain cases (e.g., carcinoid and nonsecreting paragangliomas) scintigraphy may be useful in depicting the extent and location of disease and may indicate therapeutic potential. iodine-131 MIBG shows promise in the diagnosis and staging of tumors of varied types.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/11. choriocarcinoma in mother and child, identified by immunoenzyme histochemistry.A case of metastic choriocarcinoma after term pregnancy, with tumor localization in the kidney of a hydropic stillborn infant, is presented. The primary tumor was found in a scraping four weeks after delivery. The identity and nature of the malignant growth in mother and child were substantiated by identical immunohistochemical patterns for gonadotropin activity. Because of a positive Kleihauer test it was assumed that massive feto-maternal transfusion had caused the hydrops and intrauterine death. Now, four and a half months after starting methotrexate therapy, the mother seems to be free of tumor. plasma human chorionic gonadotropin titers have decreased to normal.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/11. choriocarcinoma of the esophagus producing chorionic gonadotropin.An autopsy case of primary esophageal choriocarcinoma in a 42-year-old Japanese male is reported. The tumor was pure choriocarcinoma typical hemorrhagic and necrotic nature occupying almost the entire circumference of the mid-esophagus. The choriocarcinoma had metastasized to the liver, lung and lymph nodes. In the esophageal tumor, immunohistochemical staining showed the presence of mainly human chorionic gonadotropin (HCG), with human placental lactogen (HPL) in a few syncytiotrophoblastic cells. Only 3 cases of extragonadal choriocarcinoma originating in the esophagus have been reported up to now. The possible pathogenesis and pathological characteristics of primary esophageal choriocarcinoma are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/11. Limits of therapy for malignant chorioepithelioma.Report on two cases of malignant chorio-epithelioma following hydatidiform mole, both decreased 4 years after inception of the disease despite initially successful therapy and repeated remissions. In the first case a solitary pulmonary metastasis showing obvious de-differentiation and extensive local reparative processes was removed operatively. Associations to cytostatic medication are discussed. The second case was characterized by unusually extensive chronic pulmonary embolism with highly regressive choriocardinomatous aggregates. death resulted unexpectedly from chronic dextrocardial insufficiency. It is stressed that the treatment is subject ot limitations of not only relative (i.e., resistance to cytostatics, inadequate treatment etc.) but also of an absolute nature, as in case 2.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/11. Perinephric hemorrhage from metastatic carcinoma to the kidney.Retroperitoneal hemorrhage caused by a renal tumor is usually due to a renal cell carcinoma or angiomyolipoma. The authors report a case of computed tomographic (CT) demonstration of renal metastases from choriocarcinoma with an associated perinephric hemorrhage. The CT features indicated the acute nature of the hematoma and its confinement within the extracapsular compartment of the perirenal space.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/11. High retroperitoneal lymphocele: unusual clinical presentation and diagnosis by ultrasonography.A case of a mid lumbar lymphocele secondary to retroperitoneal lymphadenectomy for testicular carcinoma is described. The clinical picture was unusual and confusing in that the symptoms were gastrointestinal in nature. Ultrasound provided the diagnosis and guidance for aspiration. Although the most common operative source of lymphocele formation appears to be the pelvic lymphatics similar collections may arise from para-aortic and renal hilar dissections and produce unusual manifestations. Ultrasound is of established value in such cases.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/11. Severe nephrotoxicity: a probable complication of cis-dichlorodiammineplatinum (II) and cephalothin-gentamicin therapy.A 53-year-old patient with metastatic testicular choriocarcinoma died of renal failure after treatment with cis-platinum and antibiotics. serum creatinine was first noted to be elevated on day 8 of cis-dichlorodiammineplatinum (DDP) therapy. However, a sharp rise in its level occurred soon after the start of antibiotic therapy with cephalothin, gentamicin and carbenicillin. Renal failure was progressive in nature and persisted until death occurred on day 24 of therapy and after 8 days of antibiotic treatment. The most likely explanation for the progressive worsening of renal function in this patient was renal injury incurred by DDP and antibiotics. The combination of cephalothin-gentamicin should be discouraged in the treatment of patients receiving platinum.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/11. Metastatic cerebral choriocarcinoma coexistent with a viable pregnancy.Gestational choriocarcinoma associated with a viable pregnancy is extremely rare, and such choriocarcinoma with metastases presenting during the pregnancy is even more exceptional. Metastases from this tumor may present in a variety of ways depending on the site of the metastatic lesion, and can be fatal before choriocarcinoma is even suspected. We describe a 32-year-old primigravida presenting at 31 weeks gestation with a grand mal seizure due to cerebral metastases secondary to gestational choriocarcinoma who was subsequently successfully treated with chemotherapy. To our knowledge this is the first reported case of choriocarcinoma presenting with signs due to cerebral metastases during pregnancy where both the mother and child survived. This paper emphasizes the need to consider metastatic choriocarcinoma in any gravid female who presents with unusual neurological signs because of the life-threatening nature of this potentially curable disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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