Choriocarcinoma Syndrome: A Rare and Serious Complication of Testicular Germ Cell Tumors.

Choriocarcinoma syndrome is a rare complication of metastatic germ cell tumors. The hallmark of the condition is metastatic tumor hemorrhage. We describe the case of a 28-year-old man with metastatic testicular choriocarcinoma who presented with dyspnea on exertion and lightheadedness. Symptoms started two days after completing cycle one of fractionated bleomycin, etoposide, and cisplatin (BEP) chemotherapy. Laboratory investigations showed severe anemia, with a hemoglobin of 5.4 mg/dL (normal: 13-17 mg/dL). His baseline hemoglobin was 15.1 mg/dL before chemotherapy initiation. Coagulation and hemolysis workup showed no significant evidence of disseminated intravascular coagulopathy or autoimmune hemolysis. Imaging showed a significant increase in the size of previous metastatic liver lesions with surrounding hypodensity representing hemorrhage. He was admitted to the intensive care unit and started on massive transfusion protocol. On the same day, he developed a maroon-colored stool. Urgent upper endoscopy showed blood in the entire stomach and the second part of the duodenum spurting out through the ampulla, which suggested bleeding from metastatic liver lesions into the biliary tree. No defined culprit vessel was identified on visceral angiography. Endoscopic and surgical interventions were unlikely to be successful in controlling the bleeding due to the diffuse nature. He underwent one dose of radiation therapy to the abdomen, which was successful in controlling the bleeding. He survived, and his chemotherapy was switched to etoposide, ifosfamide, and cisplatin (VIP) with no further episodes of bleeding.

Progression of a hepatosplenic gamma delta T-cell leukemia/lymphoma on hyperCVAD/MTX and ara-C: literature review and our institutional treatment approach.

A 24-year-old male presented with abdominal pain, fever, and palpable splenomegaly. His differential count revealed myelocytes, metamyelocytes, and nucleated red cells. A bone marrow biopsy confirmed a diagnosis of hepatosplenic gamma delta T-cell leukemia/lymphoma. We describe here our center's diagnostic and treatment approach for this rare leukemia.

A Rare Case of Metastatic Desmoplastic Small Round Cell Tumour: Diagnosis and Management.

A 26-year-old male without any significant past medical history presented to the hospital with shortness of breath, cough, pleuritic chest pain, and weight loss for the past 3 months. On chest CT, he was found to have extensive mediastinal and hilar lymphadenopathy and multiple pulmonary nodules. On physical examination, a right groin mass was noted which had been slowly growing for the past 2 years. Ultrasound of the groin showed complex solid mass with internal vascular channels. CT guided biopsy of the mass showed desmoplastic small round cell tumour. His hospital course was complicated by hypoxic respiratory failure requiring emergent intubation and ICU admission where he completed one cycle of vincristine, cyclophosphamide, and doxorubicin with subsequent improvement, followed by extubation. His condition continued to improve after second cycle of chemotherapy and he was ultimately discharged in a stable condition to continue outpatient chemotherapy after a 2-month inpatient stay.

A trimodality approach in the management of metastatic low-grade epithelioid hemangioendothelioma of the bone.

A 29-year-old man presented with a 2-week history of severe pain in the left foot with no preceding history of trauma. A left foot radiograph demonstrated a cortical lucency in the mid-distal shaft of the third metatarsal bone. MRI of the left foot showed an expansile lesion in the same location. A staging bone scan showed a focal uptake in the known lucency in the left third metatarsal and in the proximal left femur. A subsequent left hip radiograph demonstrated a lucency in the intertrochanteric region. CT scan of the chest, abdomen and pelvis was unremarkable. A biopsy of the left third metatarsal expansile lesion performed during an incision and curettage procedure revealed an epithelioid haemangioma (EHE) of the bone. MRI of the left hip performed in response to the findings on the bone scan showed metastatic disease in the left intertrochanteric region. A prophylactic left hip fixation surgery with an interlocking intramedullary femoral nail was therefore undertaken to avoid a pathological fracture of the left hip from the metastatic disease. Simultaneously, a left hip biopsy was performed, which also revealed an EHE. The patient underwent external beam radiation to the left femoral head and neck. This was followed by fractionated radiosurgery to the left third metatarsal. Once the left foot wound had healed, the patient subsequently received four cycles of doxorubicin and ifosfamide. A restaging positron emission tomography CT carried out after completion of therapy showed no metabolic evidence of residual primary tumour or metastasis. More than 2 years after completing his trimodality therapy, the patient remains fully functional and symptom free.

A case series of emphysematous pyelonephritis.

Introduction. Emphysematous pyelonephritis (EPN) is an uncommon infection characterized by gas in the renal parenchyma and surrounding tissues. It is rapidly progressive, requiring appropriate therapy to salvage the infected kidney. Case Description. The case series presents 5 patients with a clinical and radiologic diagnosis of EPN. Each patient had a unique predisposing factor for developing EPN. Early goal directed therapy with intravenous fluids and antibiotics was given. This was followed by less invasive urologic interventions in an attempt to avoid nephrectomy and thereby salvage the infected kidney. All five patients were discharged in clinically stable conditions. Discussion and Conclusion. This case series provides added practice based support to available literature for managing EPN. Early goal directed medical therapy for sepsis coupled with interventional urologic procedures is a valuable alternative to circumvent an upfront emergent nephrectomy, except in cases where a fulminant infection may be present at the time of admission or develop later on in the course of the patients illness despite conservative line of therapy. It also highlights the importance of considering a diagnosis of EPN in patients with urinary infections, who have certain common predisposing factors listed in our case series.

A Case of Septic Arthritis of the Wrist due to Finegoldia magna.

Finegoldia magna (F. magna) has been described as one of the most frequent pathogens in the etiology of postoperative and prosthetic implant associated septic arthritis. In this report, we document our first experience with septic arthritis of the wrist caused by F. magna occurring in a joint with primary disease from prior trauma.