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Peng H, Li L, Bi Y. Successful management of nongestational ovarian choriocarcinoma complicated with choriocarcinoma syndrome: A case report and a literature review. Curr Probl Cancer 2020; 44:100539. [PMID: 31987522 DOI: 10.1016/j.currproblcancer.2020.100539] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/24/2019] [Accepted: 01/08/2020] [Indexed: 11/15/2022]
Abstract
Nongestational ovarian choriocarcinoma (NGOC) accounts for <1% of ovarian germ cell tumors and may develop into the rare and fatal complication of choriocarcinoma syndrome. We reported a case of a 12-year-old girl with NGOC that metastasized to the lungs, retroperitoneal lymph nodes and brain. On day 2 of chemotherapy with actinomycin D and etoposide, choriocarcinoma syndrome developed due to a massive pulmonary hemorrhage, presenting as acute respiratory distress syndrome. The patient received mechanical ventilation and multimodal support and completed two cycles of an actinomycin D and etoposide regimen with intubation. After the patient's acute respiratory distress syndrome was under control, she received 9 cycles of more intensive chemotherapy regimens and achieved complete remission. An exploratory laparotomy with salpingo-oophorectomy confirmed ovarian choriocarcinoma. The patient remained disease-free at a 3-month follow-up visit. In conclusion, appropriate management consisting of multimodal support and timely, sequential and intensive chemotherapy is effective for NGOC complicated with choriocarcinoma syndrome. Stating with mild regimens would probably reduce the risk of choriocarcinoma syndrome, or at least lessen its severity. To our knowledge, we presented the first report of NGOC-related choriocarcinoma syndrome.
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Affiliation(s)
- Hongfa Peng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of Obstetrics and Gynecology, The Sencond Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China.
| | - Yalan Bi
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
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Lavoie JM, Kollmannsberger CK. Current Management of Disseminated Germ Cell Tumors. Urol Clin North Am 2019; 46:377-388. [DOI: 10.1016/j.ucl.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thoracic Manifestations of Genitourinary Neoplasms and Treatment-related Complications. J Thorac Imaging 2019; 34:W36-W48. [PMID: 31009398 DOI: 10.1097/rti.0000000000000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Genitourinary (GU) malignancies are a diverse group of common and uncommon neoplasms that may be associated with significant mortality. Metastases from GU neoplasms are frequently encountered in the chest, and virtually all thoracic structures can be involved. Although the most common imaging manifestations include hematogenous dissemination manifesting with peripheral predominant bilateral pulmonary nodules and lymphatic metastases manifesting with mediastinal and hilar lymphadenopathy, some GU malignancies exhibit unique features. We review the general patterns, pathways, and thoracic imaging features of renal, adrenal, urothelial, prostatic, and testicular metastatic neoplasms, as well as provide a discussion of treatment-related complications that might manifest in the chest. Detailed reporting of these patterns will allow the imager to assist the referring clinicians and surgeons in accurate determination of the stage, prognosis, and treatment options available for the patient. Awareness of specific treatment-related complications further allows the imager to enhance patient safety through accurate and timely reporting of potentially life-threatening consequences of therapies.
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Rejlekova K, Cursano MC, De Giorgi U, Mego M. Severe Complications in Testicular Germ Cell Tumors: The Choriocarcinoma Syndrome. Front Endocrinol (Lausanne) 2019; 10:218. [PMID: 31031704 PMCID: PMC6474390 DOI: 10.3389/fendo.2019.00218] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/18/2019] [Indexed: 02/02/2023] Open
Abstract
Testicular germ cell tumors (TGCTs) represent the most common solid tumor in young men and is a model of curable cancer. The effectiveness of cisplatin-based chemotherapy secures more than 95% of patients' 5-years survival rate. However, some high-risk patients with a very advanced disease develop choriocarcinoma syndrome (CS) connected with acute respiratory failure with poor prognosis and high mortality rate shortly after beginning systemic chemotherapy. CS was first described as a syndrome with hemorrhage from metastatic sites in patients with TGCTs with significantly high choriogonadotropin level. Acute hemorrhage to lung metastases is typical, but hemorrhage can occur from any metastatic site. Patognomic of choriocarcinoma cells is an invasion of small blood vessels within CS. The incidence of CS in patients with TGCTs are not well-defined and can vary across the world. To date, there are a few case reports and small retrospective series reporting a connection between systemic chemotherapy and the development of CS in metastatic TGCTs. CS is known to be triggered by massive tumor cell lysis as a result of chemotherapy and cytokine release, aggravated with alveolar hemorrhage. This can lead to a consecutive superinfection, furthered with neutropenia after chemotherapy, acute respiratory distress syndrome, rising to systemic inflammatory response, resulting in multiorgan failure and death. A reasonably effective approach in patients with extensive disease could be a shortened course of chemotherapy as well as a reduction of dosage in induction chemotherapy before full-dose chemotherapeutical regimen; however, current data regarding optimal treatment approach are limited. Patients' referral to tertiary centers and the administration of induction chemotherapy in an intensive care unit setting could further improve the treatment outcome.
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Affiliation(s)
- Katarina Rejlekova
- 2nd Department of Oncology, Faculty of Medicine, National Cancer Institute, Comenius University, Bratislava, Slovakia
| | | | - Ugo De Giorgi
- Medical Oncology Department, Instituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, National Cancer Institute, Comenius University, Bratislava, Slovakia
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Alsharedi M, Elmsherghi N, Haydock MM, Bukamur H. Chemotherapy-related acute respiratory distress syndrome in germ cell tumors: a literature review. Med Oncol 2017; 34:56. [PMID: 28260213 DOI: 10.1007/s12032-017-0913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/28/2017] [Indexed: 11/28/2022]
Abstract
Germ cell tumors (GCTs) are one of the more curable solid cancers in men. Approximately 8500 men are diagnosed with GCTs in the USA. The majority of patients survive due to the availability of effective treatment. Fewer than 400 men are estimated to die from their disease. Among those, there is a subset of patients with metastatic GCTs receiving chemotherapy who rapidly develop progressive respiratory failure and die during the early phase of their treatment course. In this review, we searched the available literature for reported cases and retrospective series of chemotherapy-associated acute respiratory distress syndrome in GCTs. We aim to determine whether a different approach from current treatment guidelines could be considered to prevent this catastrophic chemotherapy-related event.
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Affiliation(s)
- Mohamed Alsharedi
- Division of Hematology and Oncology, Edwards Comprehensive Cancer Center at Cabell Huntington Hospital, Joan C. Edwards School of Medicine, Marshall University, 1400 Hal Greer Blvd., Huntington, WV, 25701, USA.
| | - Nabiha Elmsherghi
- Edwards Comprehensive Cancer Center at Cabell Huntington Hospital, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Maria Monica Haydock
- St. George's, University of London, London, UK.,Joan C. Edward School of Medicine, Marshall University, Huntington, WV, USA
| | - Hazim Bukamur
- Department of Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
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Bandyopadhyay D, Vijhani P, Farver C, Choudhary C. Another Case of Pulmonary Edema or May Be Not: An Unusual Presentation of Metastatic Melanoma. World J Oncol 2014; 5:183-186. [PMID: 29147401 PMCID: PMC5649746 DOI: 10.14740/wjon734w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 11/15/2022] Open
Abstract
Melanoma is a tumor of pigment producing cells melanocytes. Malignant melanoma is associated with a high morbidity and mortality because of its widespread and rapid metastasis. Melanoma commonly metastasizes to lung and secondary metastatic pulmonary melanoma is a well known entity. Metastatic melanoma can present with varied pattern of pulmonary involvement ranging from post obstructive pneumonia to atelectasis. However, lung involvement is not known to cause hypoxic respiratory failure. Here, we describe a rare case of metastatic melanoma presenting as an acute respiratory distress syndrome requiring mechanical ventilation.
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Affiliation(s)
- Debabrata Bandyopadhyay
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Praveen Vijhani
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Carol Farver
- Department of Anatomic Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Chirag Choudhary
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Worster A, Sharma S, Mookadam F, Opie J. Acute presentation of choriocarcinoma: a case study and review of the literature. CAN J EMERG MED 2012; 4:111-4. [PMID: 17612431 DOI: 10.1017/s1481803500006230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report an unusual case of a 27-year-old male with an acute presentation of choriocarcinoma. The patient presented with unstable vital signs, severe anemia and a widened arterial pulse pressure following a several day history of testicular pain. He was subsequently diagnosed as having testicular choriocarcinoma with multiple hepatic metastases and large hemorrhagic para-aortic lymph nodes. The widened pulse pressure persisted during fluid resuscitation and correction of both the anemia and hypotension, and only narrowed after the initiation of chemotherapy. A literature review indicates that metastatic testicular choriocarcinoma is a rare but aggressive malignancy that often presents with acute symptoms and signs that cause patients to seek emergency care. We summarize the reported cases of "acute" testicular choriocarcinoma presentation and briefly discuss its relationship to widened arterial pulse pressure.
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Affiliation(s)
- Andrew Worster
- Department of Emergency Medicine, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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Honecker F, Bokemeyer C. Patients with advanced non-seminomatous germ-cell tumour: the art of the start. Ann Oncol 2010; 21:1569-1571. [DOI: 10.1093/annonc/mdq262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kirch C, Blot F, Fizazi K, Raynard B, Theodore C, Nitenberg G. Acute respiratory distress syndrome after chemotherapy for lung metastases from non-seminomatous germ-cell tumors. Support Care Cancer 2003; 11:575-80. [PMID: 12783290 DOI: 10.1007/s00520-003-0481-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2003] [Accepted: 04/08/2003] [Indexed: 11/26/2022]
Abstract
GOALS To describe an acute respiratory distress syndrome (ARDS) occurring after chemotherapy for non-seminomatous germ-cell tumors (NSGCT) with diffuse lung metastases, we conducted a retrospective study in a 15-bed intensive care unit (ICU) in a comprehensive cancer center. PATIENTS AND METHODS During a 10-year period, 16 consecutive patients with diffuse lung metastases from a NSGCT were admitted to the ICU for respiratory distress and high-risk chemotherapy. MAIN RESULTS Nine patients developed acute respiratory failure requiring mechanical ventilation (MV) within 3 days of the initiation of chemotherapy, while the respiratory status of the seven other patients improved. The evolution was independent of tumor marker levels and the type of chemotherapy regimen. The SAPS II score did not accurately describe the severity of this population. The only predictor of intubation was the initial PaO2/FiO2 ratio upon admission to the ICU. Six out of seven patients who did not require MV were discharged alive from the hospital, whereas all but one patient requiring MV died. Refractory hypoxemia and ventilator-associated pneumonia were the leading causes of death. CONCLUSIONS Acute respiratory distress in patients with lung metastases from NSGCT is a rare cause of ARDS. Chemotherapy could be responsible for triggering the respiratory worsening. Patients with severe respiratory insufficiency (PaO2 <70 mmHg on room air) on admission to hospital should be promptly transferred to the ICU for the first chemotherapy course.
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Affiliation(s)
- C Kirch
- Service de Réanimation Polyvalente, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France
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Sahraoui S, Hassani AT, Ouhtatou F, Acharki A, Benider A, Kahlain A. Choriocarcinome pur du testicule : à propos d'un cas avec revue de la littérature. ACTA ACUST UNITED AC 2001; 35:125-8. [PMID: 11355283 DOI: 10.1016/s0003-4401(01)00005-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of a young man 31 years old treated at the Ibn Rochd Oncology Center for a pure choriocarcinoma of the right testis. The first examination note a skin metastasis without another localization. The beta HCG level was 328 mu/mL. The diagnosis was confirmed by pathological examination of the testis after orchidectomy. The adjuvant treatment consisted in chemotherapy like using in germ cell neoplasm's of the testis. During the evolution, partial remission (50%) was obtained after the third course and complete remission one month after the end of treatment. The patient still alive after 20 months.
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Affiliation(s)
- S Sahraoui
- Centre d'oncologie Ibn Rochd, CHU Avérroes Casablanca, Maroc.
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Glass MA, Meacham RB. Typical and Atypical Presentations of Testicular Carcinoma. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1997. [DOI: 10.1177/875647939701300103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Testicular carcinoma most commonly presents as a testicular mass. Approxiately 10-15% of patients, however, present with manifestations of metastatic disease. The reported clinical presentations of metastatic testicular carcinoma are varied and include abdominal mass, hemoptysis, adenopathy, respiratory difficulty, anorexia, nausea, vomiting, lumbar back pain, and lower extremity swelling. A comprehensive review of the literature indicated that testicular carcinoma presents as a testicular abnormality 90% of the time. In 10% of cases, however, the patients will present with nontesticular manifestations of metastatic disease. The authors provide a summary of reported nontesticular presentations of testis cancer and describe a unique case wherein the clinical presentation was spontaneous ejaculatory failure.
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Affiliation(s)
- Michael A. Glass
- University of Colorado Health Sciences Center, Division of Urology, Denver, Colorado
| | - Randall B. Meacham
- University of Colorado Health Sciences Center, Division of Urology, C-319, 4200 E. 9th Avenue, Denver, CO 80262
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Abstract
Intensive care is increasingly used in the management of cancer patients. The main reasons for admitting a cancer patient to an intensive-care unit are postoperative recovery, critical complications of the cancer disease and its treatment, the administration and monitoring of intensive anticancer treatment, and acute disease unrelated to cancer or its treatment. The present review is focused on the prognosis of critically ill cancer patients, on the description of the types of complications requiring intensive care, on specific aspects of the application of critical-care techniques in cancer patients, on ethical considerations and on ICU organization in the context of oncology.
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Affiliation(s)
- J P Sculier
- Unité d'Administration et de Surveillance de Traitements Intensifs (ASTI), l'Université Libre de Bruxelles, Belgium
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