RESUMO
Testicular cancer is among the most common solid tumors in young men. Gastrointestinal tract (GIT) metastasis of testicular cancer has been rarely reported. In addition, metastasis occurs most commonly through retroperitoneal lymph nodes. Manifestations like abdominal pain and obstruction can be present if metastasis to GIT was considered. We report here a case of a 34-year-old male who was admitted to our GIT unit complaining of episodic epigastric pain. Computed Tomogram (CT) scan demonstrated a soft tissue like lesion involving the lumen of duodenum. Moreover, the patient had a right radical orchiectomy 18 months prior to the presentation due to a stage IA non-seminomatous germ cell tumor with no lymphovascular invasion and free surgical margins. Esophagogastroduodenoscopy (EGD) revealed a malignant appearing duodenal lesion and biopsy showed that it was compatible with germ cell tumor. Metastatic embryonal carcinoma to duodenum was diagnosed and confirmed by immunohistochemical stains. Then, the patient's situation was discussed and decided to be on a plan of four cycles of chemotherapy regimens. Testicular malignancy metastasis to GIT is uncommon, but it's important to know that there is a contact between GIT and testicular lymphatic drainage through para-aortic lymph nodes. So, even if it's rare to occur, it's still possible, and we should always be concerned about it. Mostly, diagnosis of testicular tumors begins with evaluating tumor markers such as alpha-fetoprotein (AFP), beta-subunit of human chorionic gonadotropin (B-hCG), and lactate dehydrogenase (LDH). But in contrast, all of these markers were within the normal range of their values in our case. Suspicion for metastasis and GIT involvement must be raised when dealing with a young male who had a history of testicular tumor such as embryonal carcinoma which was reported here in our case. That is very essential for avoiding potential complications and saving time in order to start management.
RESUMO
Sarcoidosis is a multisystemic, noncaseating granulomatous disease of unknown etiology. Neurosarcoidosis (NS) is the involvement of the central nervous system (CNS) in sarcoidosis, and it occurs in approximately 5%-10% of cases. NS can present with a variety of clinical features, making diagnosis challenging. A comprehensive diagnostic approach is required to obtain a definitive diagnosis. In this case we present a 13-year-old boy with diabetes mellitus presented with acute right-sided weakness, paresthesia, headaches, and episodes of loss of consciousness, followed by confusion and aggressive behavior. Neurological examination revealed right-sided motor and sensory deficits, as well as abnormal reflexes. Cranial imaging revealed a solitary lesion in the left centrum semi-ovale. Cerebrospinal fluid (CSF) analysis showed lymphoblastic leukocytosis, increased CSF angiotensin-converting enzyme (ACE), and a high IgG index. Extensive laboratory and imaging studies ruled out other potential etiologies. This case presented with a unique set of clinical features, including a mass lesion effect and seizures, which are uncommon in isolated NS. The patient responded well to high-dose corticosteroid therapy, with resolution of his symptoms. Levetiracetam was used to effectively manage his seizures.
