ABSTRACT
BACKGROUND: Germ cell tumors (GCTs) account for 2% of human malignancies but are the most common malignant tumors among males aged 15-35. Since 1983, an association between mediastinal GCT (MGCT) and hematologic malignancies has been recognized. CASE SUMMARY: We report a case in which malignant histiocytosis was associated with mediastinal GCTs. The clinical data of a male patient with MGCT admitted to Beijing Children's Hospital were collected retrospectively. The patient was first diagnosed according to imaging and pathological features as having MGCT, and was treated with surgery and chemotherapy. One year after stopping chemotherapy, imaging showed metastases in the right supraclavicular, mediastinum, hilar region and retroperitoneal lymph node, right pleura, right lung, and right para-cardiac margin. Pathological diagnosis of the liver nodular and hilar lymph nodes included systemic juvenile xanthogranuloma and Rosai-Dorfman lesions with malignant transformation (i.e., morphological characteristics and immunophenotype of histiocytic sarcoma). Following diagnosis, the patient accepted chemotherapy with vindesine, cytarabine and dexamethasone. Positron emission tomography-computed tomography showed partial remission. The patient was followed-up for 10 mo after the diagnosis of malignant histiocytosis, and no sign of progression or relapse was observed. CONCLUSION: Physicians should recognize the possibility of hematologic malignancies being associated with MGCT. Suitable sites should be selected for pathological examination.
ABSTRACT
Reality therapy has been demonstrated to be an effective strategy in achieving behavioral change. This case study used reality therapy as a therapeutic communication tool to help improve the family relationships of a client with schizophrenia. We used a four-tiered questioning technique to address, respectively, the aspects of "want," "doing/direction," "evaluation" and "plan" (WDEP). Nursing interventions were held between October 21st and November 19th, 2010. The authors used the reality therapy framework and WDEP system to guide the client to explore her inner needs, review problems objectively, and determine where efforts could be focused most effectively. Better appreciation of her abilities and strengths and encouragement of effective actions helped improve client relationships with her family members. This study introduced reality therapy and shared clinical experiences in order to help readers better understand reality therapy as an alternative framework of communication in nursing care.
