1/7. Case of gonadoblastoma in a 9-year-old boy without physical abnormalities.BACKGROUND: A 9-year-old boy was admitted to Jikei University Hospital complaining of gradual enlarging of the left scrotal contents. methods/RESULTS: physical examination was significant for bilateral descended testicles. No abnormalities were detected in the testicles or along the spermatic cords. Scrotal ultrasound showed that hyperechoic shadows were recognized in the central area of the left testicle. Subsequent testicular biopsy and histopathological examination showed intratubular malignant germ cells in the testicular tubules. One week later, left orchiectomy was performed. CONCLUSIONS: Histopathological evaluation revealed gonadoblastoma. gonadoblastoma, a rare gonadal neoplasm, is composed of germ cells and sex cord derivatives and usually occurs in phenotypically female patients with gonadal dysgenesis. To date, only three cases of gonadoblastoma have been reported in anatomically normal male patients with scrotal testicles. We report on a case of gonadoblastoma unaccompanied by a germ cell tumor in a physically normal male.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/7. Retroperitoneal germ cell tumor treated by PVeBV chemotherapy: a case report.The extragonadal germ cell tumor are uncommon neoplasms which account for only 1-5% of germ cell tumors, and its prognosis is poor. We report here the use of combination chemotherapy with cisplatin, etoposide, bleomycin, and vinblastine (PVeBV) for the treatment of retroperitoneal germ cell tumor. A 28-year-old male with complaints of abdominal pain and lumbago, without any abnormality in both testes by physical and ultrasonographic examination, showed retroperitoneal tumor by abdominal computed tomography. The serum alpha-fetoprotein and lactate dehydrogenase were elevated. The retroperitoneal tumor was treated surgically. The pathological diagnosis was mixed germ cell tumor. The lung and supraclavicular lymph node metastases disappeared completely after 3 courses of PVeBV chemotherapy with cisplatin (40 mg/m2 per day) and etoposide (100 mg/m2 per day) for 5 consecutive days, with vinblastine (0.2 mg/kg) on day 1, and bleomycin (30 mg/body) given on days 1, 8, and 15. granulocyte colony-stimulating factor and serotonin receptor antagonist application were available on acute phase toxic effects. The patient is now alive and well, without recurrence, more than 26 months after the operation.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
3/7. Recognizing abnormal marker results that do not reflect disease in patients with germ cell tumors.PURPOSE: The judicious use of serum alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase is key to appropriate management of patients with germ cell tumors. Elevated AFP and/or HCG generally indicate active disease. We describe patients with germ cell tumors who had elevated serum AFP and/or HCG but no active disease, despite careful repeat evaluation. MATERIALS AND methods: Histories of 6 cases of germ cell tumors that remained in remission despite abnormal serum AFP and/or HCG were reviewed. RESULTS: Markers were only modestly elevated, remained constant or spontaneously normalized during repeat measurements, and there was no other clinical or radiographic evidence of disease. patients were treated conservatively with physical examination, radiological tests and repeat marker assays, with no relapse to date. CONCLUSIONS: Stable, low increases in serum AFP and HCG may not represent active disease. Careful repeat evaluation will determine whether the markers increase. If no change is noted after appropriate studies have been reviewed by an experienced practitioner to exclude active disease from diagnosis, then consideration should be given to managing such cases with close surveillance to avoid unnecessary chemotherapy.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
4/7. Acute scrotum due to arterial bleeding mimicking non-seminomatous germ cell tumor.Men with testicular tumors usually present with painless increase in testis size incidentally noticed by the patient. We report a case of a young patient presenting as an emergency with acute onset of massive right-sided testicular pain without previous injury. After physical examination testicular torsion could not be excluded. Ultrasound examination of the testis was suspicious for testicular tumor. Surgical exploration of the right testis by inguinal approach was performed revealing subcapsular arterial bleeding due to a small nonseminomatous germ cell tumor non-palpable on clinical examination.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
5/7. diabetes insipidus as an early sign of pineal tumor.A 13-year-old boy's acute onset of diabetes insipidus was the first manifestation of a pineal tumor. One year after the physical symptoms of diabetes insipidus occurred, neurological examinations, tumor markers, and computed tomography brain scan were all normal. Three years later, rapid development of neurological changes was observed with the prevailing symptoms of increased intracranial pressure. The changes were related to a pineal germ cell tumor identified by a high level of beta-human chorionic gonadotropin in plasma and neuroradiological investigations, including computed tomography and magnetic resonance imaging. The clinical course of this case is unusual and we advocate the following: (1) the follow-up of children with diabetes insipidus is important for determining whether or not it is an idiopathic type and (2) elevation of plasma beta-human chorionic gonadotropin and development of neurological signs in patients with so-called idiopathic diabetes insipidus should arouse clinical suspicion of an intracranial germ cell tumor. It should be noted that the brain tumor is significant as the underlying pathology of childhood diabetes insipidus.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
6/7. Late seminomatous relapse of a mixed germ cell tumor of the testis on intensive surveillance.We report a case of a pure seminomatous relapse in the retroperitoneum 6 years after orchiectomy for an apparent stage I mixed germ cell tumor of the testis. The 4 cm. metastatic mass was not imaged on computerized tomography, tumor markers were negative and confounding symptoms made diagnosis difficult. The propensity for seminomatous tumors to relapse later than nonseminomatous tumors has profound implications for intensive surveillance programs for apparent stage I disease in mixed germ cell tumors. These programs often involve routine computerized tomography only for the first 2 years and rely on physical examination, simple radiology and serum tumor markers thereafter. Such programs may fail to detect pure seminomatous relapse and delay the onset of curative treatment.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
7/7. Abdominal mass in a young woman. Pitfalls and delayed diagnosis. Case report.Although germ cell tumors arising from adnexa are relatively frequent among young women, diagnosis is often delayed by omitting basic diagnostic procedures. This case report highlights the importance of using the available diagnostic tools beginning from the simplest one, i.e., physical examination, to the most sophisticated and reliable one (ultrasonography). Diagnostic pitfalls and management of a massive ovarian tumor in an 18 year-old woman are reported.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |