1/21. 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 = pregnancy (Clic here for more details about this article) |
2/21. Successful treatment with ICSI of infertility caused by azoospermia associated with adrenal rests in the testes: case report.Congenital adrenal hyperplasia (CAH) is a well-recognized, but uncommon, cause of azoospermia and infertility in men. Commonly this is due to undertreatment of excessive adrenal androgen secretion which suppresses gonadotrophin stimulation of the testes. A less common complication of CAH is development of adrenal tissue within the testes; this is important to recognize because it may be confused with malignancy leading to unnecessary surgery. In this case report, a man is described with simple virilizing CAH due to 21-hydroxylase deficiency who presented with azoospermia and was found to have adrenal rests. Investigations concluded that there was adequate adrenal suppression with glucocorticoids and that azoospermia was due to obstruction by adrenal rest tissue, strategically situated at the hilum of the testes. spermatozoa were able to be retrieved by testicular aspiration from the man and these were used to successfully establish a pregnancy using intracytoplasmic sperm injection of his wife's oocytes.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
3/21. Testicular choriocarcinoma metastatic to the skin: an additional case and literature review.choriocarcinoma, a malignancy of trophoblastic cells, is characterized by the secretion of human chorionic gonadotropin (hCG). choriocarcinoma primarily arises from the fetal (placental) trophoblasts in the setting of a molar pregnancy. Nongestational choriocarcinoma from the ovary or testis is much rarer. Testicular choriocarcinoma is a malignant tumor with great propensity for distant metastasis. The primary sites of metastasis are the lungs, liver, and brain. skin metastasis is very rare but portends a grave prognosis when diagnosed. We present the case of a 24-year-old white male with a testicular mixed germ-cell tumor with skin metastases of choriocarcinoma.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
4/21. Significant medical pathology discovered during a male infertility evaluation.PURPOSE: Because a pregnancy can be achieved without a male infertility evaluation, some have questioned its usefulness. However, by bypassing a urological evaluation the man might not learn the cause of infertility and not be offered specific corrective therapy. In addition, men with subfertility may have a serious underlying medical or genetic problem that could also be overlooked. We determine the incidence of significant medical pathology discovered during a male infertility evaluation at 2 academic infertility practices. MATERIALS AND methods: All men examined for either primary or secondary infertility were included in our study, while men seen for vasectomy reversal were not. All patients underwent evaluation, consisting of a complete history, physical examination, semen analysis, hormone testing, urinalysis and genetic testing when appropriate. RESULTS: Significant medical pathology was discovered in 33 of 536 (6%) patients. A total of 27 patients had genetic abnormalities, including cystic fibrosis mutations in 24 and karyotypic abnormalities in 3. Of the remaining 6 patients 1 had testis cancer, 1 prostate cancer, 3 diabetes mellitus and 1 hypothyroidism. CONCLUSIONS: Significant medical pathology can be detected by a male infertility evaluation. In addition to identifying the cause of infertility, the evaluation may uncover conditions that threaten the health of the male partner or any potential offspring.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
5/21. High levels of hCG in choriocarcinoma can result in renal failure and a false-negative pregnancy test in men.The diagnosis of choriocarcinoma was delayed because a urinary pregnancy test for hCG was falsely negative. This man's hCG rose to 25,000,000 iu/l. He developed renal impairment, probably due to precipitation of hCG in his renal rubules.- - - - - - - - - - ranking = 5keywords = pregnancy (Clic here for more details about this article) |
6/21. Testicular sperm extraction in a patient with metachronous bilateral testicular cancer.A new indication for testicular tissue cryopreservation is demonstrated in a patient with metachronous bilateral testicular tumours and azoospermia. At the age of 18 (1982) the patient underwent left orchidectomy and radical retroperitoneal lymphadenectomy for a testicular teratoma (pT1N0M0). Semen samples were not cryopreserved because of absence of motile spermatozoa after thawing. Seventeen years after the primary testicular cancer, a seminoma of the contralateral right testis was diagnosed (pT1N0M0). Since the patient was azoospermic, no semen samples could be cryopreserved. However, spermatozoa were detected in testicular biopsy material of the right testis and were cryopreserved for ICSI. Since all spermatozoa were dead after thawing, testicular sperm extraction (TESE) was performed in the remaining tissue samples at the time of ICSI treatment. Only spermatids could be extracted from frozen-thawed samples due to the inhomogeneous distribution of spermatogenic activity in the testicular tissue. Although one oocyte was fertilized with these spermatids, a clinical pregnancy was not achieved. Despite the disappointing results of ICSI in the couple presented here, this case report demonstrates that cryopreservation of testicular tissue and TESE should be considered in patients with bilateral testicular tumours and azoospermia, if frozen semen samples are not available.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
7/21. A fetal testis with intratubular germ cell neoplasia (ITGCN).A fetal testis with abnormal germ cells similar to the cells of intratubular germ cell neoplasia (ITGCN) or so-called carcinoma in situ is presented. Elective abortion was performed in week 18 of the pregnancy of a 26-yr-old woman, because of 21 trisomy (Down's syndrome) at amniocentesis. At microscopical examination abnormal germ cells were found, similar to those occurring in the adult testis and with the same distribution as those described in ITGCN in children with dysgenetic gonads and with androgen insensitivity syndrome. PAS positivity and placental-like alkaline phosphatase (PLAP) was demonstrated in the abnormal germ cells. The finding indicates that the first event of germ cell tumor oncogenesis may take place before birth, in utero or even before. The occurrence of ITGCN in Down's syndrome has not been reported previously but is likely to occur, as there is evidence that these patients have increased risk of developing germ cell tumors.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
8/21. pregnancy after subzonal insertion of cryopreserved spermatozoa from a patient with testicular seminoma.The first pregnancy established after subzonal insertion of frozen-thawed sperm obtained from a patient with seminoma and severe oligoasthenospermia is reported. A total of 800,000 sperm with a poor progressive motility were recovered after thawing. Three to seven motile spermatozoa were injected into the perivitelline space of each of 10 oocytes, and seven sibling oocytes were coincubated and inseminated with 200,000 motile sperm/mL. Only 1 of the manipulated oocytes fertilized and was transferred to the uterus 65 hours after insemination at the eight-cell stage. A healthy boy weighing 3,600 g was delivered spontaneously at 38 weeks of pregnancy. This report gives hope to patients with testicular malignancy and severely impaired sperm function to maintain their reproductive potential through sperm banking and assisted fertilization techniques.- - - - - - - - - - ranking = 2keywords = pregnancy (Clic here for more details about this article) |
9/21. Healthy girl born after cryopreservation of gametes and ICSI in a patient with seminoma.This study reports birth in a case of intracytoplasmic sperm injection with cryopreserved oocytes and spermatozoa banked after radiotherapy and prior to chemotherapy due the occurrence of two non-synchronous seminomas. A 30-year-old male with a diagnosis of seminoma cryopreserved six vials of spermatozoa. After oncological treatment was completed, his partner, a 24-year-old woman, underwent ovarian stimulation. Seventeen oocytes were retrieved; one was at the germinal vesicle stage and two were injected, resulting in two embryos. Fourteen metaphase II oocytes were frozen. The woman presented moderated ovarian hyperstimulation syndrome, and embryo cryopreservation was indicated. After endometrial preparation, two embryos were transferred and a pregnancy was achieved. The woman suffered eclampsia during week 28 of gestation. Caesarean section was performed and a preterm girl weighing 1000 g was born, but died 2 weeks after delivery. A year later, a second procedure was begun. Frozen oocytes and one vial of semen were thawed. Eight of the 14 oocytes survived and were microinjected; two became fertilized and one good quality cleaved embryo was transferred. pregnancy was achieved and a healthy girl was born with a birth weight of 2800 g. Oocyte cryopreservation associated with sperm banking in cancer patients is a useful tool for couples seeking deferred parenthood.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
10/21. Testicular neoplasm diagnosed by ultrasound.The diagnosis of testicular cancer is usually made by the findings of a testicular mass on physical examination. In rare cases a young man will present with retroperitoneal nodes and a normal testicular examination. In such cases a testicular ultrasound may localize the testis which harbors a subclinical neoplasm. In addition serum markers of B-HCG and AFP are essential. As a screening procedure a urine pregnancy test is helpful, since it can be obtained quickly while quantitative B-HCG and APF results are delayed.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
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