Burned-Out Testicular Carcinoma Presenting as Inferior Vena Cava Tumor Thrombus With Pulmonary Tumor Embolism on FDG PET/CT: A Case Report.

ABSTRACT: "Burned-out" testicular tumor is a very rare clinical phenomenon, which refers to the presence of a metastatic germ cell tumor with no clinical findings in the testicle due to spontaneous regression of the primary testicular lesion. We present an unusual case of burned-out testicular embryonal germ cell carcinoma presenting as an extensive inferior vena cava tumor thrombus with malignant pulmonary embolism in which FDG PET/CT played a pivotal role in detecting the extent and significance of the disease.

Management of Upper Tract Urothelial Carcinoma in a Double Collecting System Kidney.

Upper tract urothelial carcinoma (UTUC) in a duplex collecting system (DCS) is a relatively uncommon presentation with unclear management guidelines. Herein, we retrospectively reviewed all published cases of DCS with UTUC aiming to suggest personalized clinical care options for future cases. We conducted a systematic search for all cases of UTUC in DCS from published literature using the following keywords: UTUC, urothelial carcinoma (UC), collecting duct carcinoma, and DCS. The cases were summarized based on demographics, clinical presentation, predisposing risk factors, tumor location, management, and follow-up. We present an additional case based on our experience with a 69-year-old female with high-grade (HG) UTUC of the upper moiety in complete DCS. The patient underwent a robotic upper pole hemi-nephroureterectomy (hemi-NU) with a common sheath distal ureterectomy and a bladder cuff, followed by lower pole ureteral reimplantation. Overall, 34 patients with 35 renal units of UTUC in DCS were included and analyzed. To conclude, UTUC of DCS is rare and underreported. Hence, it is difficult to define a standard treatment. Although hemi-NU has been previously described, to the best of our knowledge, this is the first case report of robot-assisted hemi-NU for complete DCS with single-moiety UC.

Circulating Cell-Free DNA Levels in Patients with Metastatic Renal Cell Carcinoma.

BACKGROUND: Limited data about biomarkers are available to predict the outcomes of targeted therapy in metastatic renal cell carcinoma (mRCC). Circulating cell-free DNA (CFD) is elevated in various cancers. PATIENTS AND METHODS: We performed a prospective study of patients with mRCC who received targeted therapy in the Soroka Medical Center between 2013 and 2015. CFD levels were measured using a simple fluorometric assay. Blood samples for CFD were collected before treatment and at weeks 1, 4, 12, 18, and 24 of treatment. The normal cut-off level of CFD was defined as 800 ng/ml. The association of CFD with objective response, progression-free survival (PFS), and overall survival was tested, with adjustment for known confounding risk factors. RESULTS: A total of 23 patients were included; 18 were treated with first-line therapy and 5 with second- and third-line therapies. Patients with normal pretreatment CFD level had a better PFS versus patients with increased levels (p = 0.023). In multivariate analysis, factors associated with PFS were pretreatment CFD levels (p = 0.020) and Heng risk (p = 0.006). CONCLUSIONS: Elevated pretreatment CFD levels measured using a simple fluorometric assay may be associated with a worse PFS in patients with mRCC. A larger prospective study is warranted in order to validate our observation.

Successful treatment of mediastinal seminoma in a hemodialysis patient.

BACKGROUND: Extragonadal germ cell tumors (GCTs) are relatively uncommon neoplasms, affecting primarily men during the third and fourth decades of life. CASE REPORT: We describe an unusual case of mediastinal seminoma in a 21-year-old male on chronic peritoneal dialysis for renal failure of uncertain etiology. The patient was treated with chemotherapy consisting of etoposide and cisplatin (EP) combined with hemodialysis. Cisplatin (20 mg/m(2)), and etoposide (50 mg/m(2)) were given on days 1, 3, and 5 for induction. Hemodialysis was started 1 h after completion of etoposide infusion. Following this course of treatment, another 4 cycles of cisplatin (20 mg/m(2)), and etoposide (50 mg/m(2)) were given on successive days from day 1 to 5. Hemodialysis was carried out daily, prior to the start of chemotherapy. Subcutaneous PEG-filgrastim was given on day 6 in all cycles. The patient's status after the first post-induction treatment was complicated by a pseudomonas infection. Tumor response to chemotherapy was prompt with remission lasting to date, 17 months after diagnosis. CONCLUSION: This case report is the second description of chemotherapy given to a hemodialysis patient with extragonadal GCT. We suggest that treatment with EP combined with hemodialysis according to the presented protocol is feasible, and may result in a favorable outcome.

Amniotic fluid intercellular adhesion molecule-1 is a marker for Ureaplasma infection in women with preterm labor.

OBJECTIVE: The objective of the study was to determine the amniotic fluid soluble intercellular adhesion molecule-1 concentrations in women with preterm labor in relation to intra-amniotic infection. STUDY DESIGN: Amniotic fluids from 125 women with preterm labor (78 with preterm delivery and 47 with term deliveries) were examined for both soluble intercellular adhesion molecule-1 concentrations and intra-amniotic infection with Ureaplasma species. A chi2 test, or Fisher's exact test, when appropriate, was used for statistical analysis. RESULTS: In the preterm delivery group, 45% (35 of 78) had intra-amniotic infection with Ureaplasma species, compared with 19% (9 of 47) in the term delivery group (P = .004). In women with intra-amniotic infection, 26% (9 of 38) had soluble intercellular adhesion molecule-1 levels above 1290 ng/ml. Only 2.3% (1 of 43) in the preterm delivery group without intra-amniotic infection attained this diagnostic level (P = .004). In contrast, there was no significant difference in soluble intercellular adhesion molecule-1 levels between those with or without intra-amniotic infection in the term delivery group. CONCLUSION: Amniotic fluid soluble intercellular adhesion molecule-1 concentrations exceeding 1290 ng/ml can be used as a marker for intra-amniotic infection with Ureaplasma in patients with preterm labor.

Intercellular adhesion molecule-1 concentration, in utero, decreases after antibiotic treatment.

A parturient suffering from preterm premature rupture of membranes at 29-weeks of gestation was hospitalized and staphylococcus was detected in her amniotic fluid. After treatment with antibiotics she delivered a healthy neonate three weeks later. ICAM-1 levels decreased by 20 fold correlating with elimination of the bacteria and prolongation of the pregnancy.