A case of seminoma with a low level positive of serum hCG (human chorionic gonadotropin) beta considered as false positive hCGbeta

A 32-year-old male consulted a hospital with a complaint of left scrotal swelling. Serum hCGbeta and LDH levels were elevated and computed tomography demonstrated a suspicious small lymphadenopathy in the paraaortic region. Left inguinal orchiectomy was performed. Histological examination demonstrated seminoma. We diagnosed the disease as clinical stage 2A and the patient received 2 courses of chemotherapy with cisplatin, etoposide and bleomycin. After this therapy, the small lymphadenopathy in the paraaortic region did not decrease in size. We considered this lesion a vessel or connective tissue. Although he achieved clinical complete remission and serum LDH level was normalized, the serum hCGbeta level remained low level positive. Urinary hCGbeta level after chemotherapy was below the threshold of detectability. We measured the serum from this patient as well as control sera by two- and four-fold dilution with a diluent comprised of mouse serum as a heterophilic antibody-blocking agent. The serum hCGbeta level of this patient was obviously decreased; in contrast, control sera were decreased in parallel. The serum hCGbeta level of this patient remained low level positive without recurrence for 8 months after chemotherapy. These results strongly suggested that low level of positivity for serum hCGbea in this case was a false positive finding. We consider the measurement of urinary hCGbeta and dilution measurement using a heterophilic antibody-blocking agent to be useful methods of distinguishing false positive findings for serum hCGbeta.     

The role of the uncertainty of measurement of serum creatinine concentrations in the diagnosis of acute kidney injury

Uncertainty of measurement is the numeric expression of the errors associated with all measurements taken in clinical laboratories. Serum creatinine concentration is the most common diagnostic marker for acute kidney injury. The goal of this study was to determine the effect of the uncertainty of measurement of serum creatinine concentrations on the diagnosis of acute kidney injury. We calculated the uncertainty of measurement of serum creatinine according to the Nordtest Guide. Retrospectively, we identified 289 patients who were evaluated for acute kidney injury. Of the total patient pool, 233 were diagnosed with acute kidney injury using the AKIN classification scheme and then were compared using statistical analysis. We determined nine probabilities of the uncertainty of measurement of serum creatinine concentrations. There was a statistically significant difference in the number of patients diagnosed with acute kidney injury when uncertainty of measurement was taken into consideration (first probability compared to the fifth p?=?0.023 and first probability compared to the ninth p?=?0.012). We found that the uncertainty of measurement for serum creatinine concentrations was an important factor for correctly diagnosing acute kidney injury. In addition, based on the AKIN classification scheme, minimizing the total allowable error levels for serum creatinine concentrations is necessary for the accurate diagnosis of acute kidney injury by clinicians.     

Glomustumor des Magens

Glomus tumours are benign neoplasms that usually arise in the skin of the extremities but have infrequently been found to occur in other sites including the stomach.We report on a 71-year-old female with non-specific epigastric pain who was diagnosed as having a small, intramural gastric tumour in addition to a cholecystolithiasis. Intraoperatively, the tumour was investigated by frozen section, but the diagnosis remained inconclusive. The ultimate histological examination showed clusters of uniform epithelioid cells surrounding wide vascular spaces.This led to the diagnosis of a glomus tumour. In a review of the recent literature,we discuss the methods and limitations of preoperative diagnostic measures.     

Large non-secreting islet cell adenomas. Review of the literature.]

The authors report a case of benign non secretory islet cell tumour. Ten other cases of this type were found in the literature. These non-functional tumours évolve without symptoms and are rarely diagnosed in the presence of an abdominal mass. They are usually discovered at autopsy. Clinical examination and further investigation do not always demonstrate the pancreatic origin of the tumour observed. Treatment is surgical consisting of removal of the tumour. Pathological examination leads to the diagnosis of non-secretory islet cell tumour which is usually benign; only the course can confirm this.     

Dermatomyositis associated with membranous nephropathy in a 43-year-old female

A 43-year-old woman was admitted to our hospital for myalgic pain and erythema of the face and thighs. She had been diagnosed with dermatomyositis at another hospital 8 years earlier and proteinuria had developed suddenly. Renal histological examination revealed membranous nephropathy. Membranous nephropathy associated with dermatomyositis is very rare. To date, malignant disease has not been detected in our patient, but the serum level of CA125, a tumor marker, has been elevated to 1,097 U/ml. The increased CA125 level is related to the degree of proteinuria and after prednisolone and cyclosporine therapy, proteinuria and the CA125 level gradually decreased.     

The upper thoracic spinal cord compression as the initial manifestation of Wegener’s granulomatosis: a case report

There are only a few reported cases about spinal cord involvement with Wegener’s granulomatosis (WG) in the literature. In these cases, the spinal cord is usually indented or compressed by dural and meningeal masses which are characterized by necrotizing granuloma formation and vasculitis. And, it usually cannot be correctly diagnosed. A 53-year-old woman suffered from Wegener’s granulomatosis, in whom the upper thoracic spinal cord compression is the initial manifestation. The surgical biopsy and thoracic laminectomy were performed and the histologic examination was done. This patient was finally diagnosed as WG when the pathologic examination revealed as Wegener’s granulomatosis and the serum antineutrophil cytoplasmic antibodies (ANCA) were reported positive; titers of antimyeloperoxidase (MPO) antibodies were markedly elevated. After treatment with cyclophosphamide and corticosteroids this patient partially recovered from neurological involvement. In a case such as this, careful monitoring of clinical parameters is essential for assessing disease activity with repeated MRI if neurologic status changes. Serial measurement of ANCA titers may also be helpful to establish the diagnosis. Cyclophosphamide and corticosteroids are the agents of choice for induction of remission of WG.

     

Testicular tumour markers in tissue correlated to serum levels and clinical stage

Clinical investigation of 11 patients with testicular tumour included tests for the marker substances AFP (alpha fetoprotein) and HCG (human chorionic gonadotropin) in serum and in tumour tissue, using an indirect immunoperoxidase technique. In one case of pure seminoma, neither AFP nor HCG was detectable in tissue or in serum. In eight of ten patients with non-seminomatous germ cell tumour there was AFP-immunoreactivity in tumour tissue, and seven of them also had elevated serum levels of AFP. Five patients showed HCG-immunoreactivity in tumour tissue and the same number had elevated serum levels of HCG. The findings indicated good correlation between immunoreactivity of tumour tissue, serum level of the tumour markers and clinical stage of the neoplastic disease.     

Suprarenal myelolipoma: an "incidental" disease

With the development and improvement of imaging techniques, we are witnessing a greater number of disease diagnoses considered uncommon only a few years ago. When the diagnosis of a tumoral disease occurs "incidentally" while performing an imaging examination for other reasons, we name the condition "INCIDENTALOMA". A clear example of these in suprarenal conditions is the myelolipoma. Myelolipoma is a benign and non-functioning tumour originating in the suprarenal cortex and histologically consisting of mature fat and haemopoietic tissue. Given its benign and usually inactive nature, the current approach is a conservative attitude. Surgical exeresis is only accepted when large tumoral masses are present or in complicated cases. This paper presents a new case of a 10 cm suprarenal myelolipoma incidentally diagnosed during routine ultrasound examination in a 47-year old male patient. Subsequent exeresis of the suprarenal mass and pathohistological study confirmed the diagnosis.     

Surgical therapy of hepatic fibrolamellar carcinoma

Hepatic fibrolamellar carcinoma (FLC) is an uncommon tumour that differs from hepatocellular carcinoma (HCC) in demographics, condition of the affected liver, tumour markers, and prognosis. FLC characteristically manifests as a large hepatic mass in adolescents or young adults with female predominance (mean age 23 years). Cirrhosis, elevated alpha-fetoprotein levels, and risk factors for HCC such as viral hepatitis are typically absent. FLC is usually associated with serum tumour markers such as vitamin B12 binding protein, and neurotensin. FLC is characterized pathologically by cords of tumour cells surrounded by abundant collagenous fibrous tissue arranged in a parallel or lamellar distribution. FLC usually appears on radiologic images as a lobulated heterogeneous mass with a central scar in an otherwise normal liver. The clinical presentation of patients with FLC is variable. These patients commonly have pain, and palpable right upper quadrant abdominal mass. An uncommon presenting sign is gynaecomastia in men. Use of percutaneous biopsy (FNAB) is beneficial if there is diagnostic uncertainty about the radiologic diagnosis (US, CT MRI). Although FLC is frequently recurrent, patients have a better prognosis than those with HCC, and aggressive surgical liver resection with extended lymphadenectomy or liver transplantation may be indicated. The presence of advanced-stage disease, direct invasion of adjacent organs, lymphadenopathy, or limited metastasis does not preclude attempts at curative resection. In inoperable cases, the patient may benefit from chemotherapy, permitting in up to 50% of these cases a curative resection. The case is reported of a 18-year-old man with bilateral gynecomastia secondary to an unknown hepatic fibrolamellar carcinoma producing oestrogens. Serum alpha-fetoprotein was negative; des-gamma-carboxy prothrombin (DCP) level was elevated. CT scan and MRI showed a solid hepatic tumour (theta 10 cm) without evidence of extrahepatic spreading. By a needle biopsy a fibrolamellar carcinoma was diagnosed. On March 1995 a right hemihepatectomy was performed. The postoperative course was uneventful and the patient recovered. Specimen's histologic examination confirmed the preoperative diagnosis. Intracellular (hepatocytes) oestrogens were found, but oestrogen and androgen receptors were negative. After surgery DCP and oestradiol levels rapidly decreased and gynaecomastia disappeared. A follow-up program was established. On April 2000 a probable recurrence within the caudate lobe was discovered by a liver CT scan without evidence of extrahepatic spreading. Tumour markers, FNAB, and bone scintigraphy were negative. On July 2000 the patient underwent second look laparotomy. Only a coeliac lymphadenopathy was found and a lymphadenectomy performed. Specimen's histologic examination showed a metastatic lymph nodal disease (FLC). The postoperative course was uneventful and the patient recovered. He is currently alive without evidence of recurrence 5 years after the second operation.     

Unusual gestational choriocarcinoma arising in an interstitial pregnancy

INTRODUCTION

Choriocarcinoma is a highly malignant trophoblastic neoplasm. Its association with ectopic pregnancy is very rare and usually with aggressive behavior.

PRESENTATION OF CASE

We report a new case arising in an interstitial pregnancy occurring in a 46-year-old woman. The patient was admitted for severe pelvic pain and abundant metrorrhagia. One month ago, she had had a laparoscopic resection of an interstitial pregnancy subsequent to failure of chemotherapy by methotrexate. The raise of serum βhCG level and the hyperechoic intrauterine mass were in favor of gestational trophoblastic disease. Urgent laparotomy was performed for circulatory collapse. Hysterectomy was done. Histological examination revealed a choriocarcinoma. The patient underwent chemotherapy. Two years later, neither metastasis nor recurrence was detected.

DISCUSSION

Clinical diagnosis of primary interstitial choriocarcinoma is difficult, since it is rare and manifesting by non-specific abnormal vaginal bleeding. Imaging findings are also not helpful in ectopic location. The frequency of metastasis is related to the delayed diagnosis. Serial measurement of βhCG level was the most useful marker of diagnosis and follow up. Histopathological examination remains the only tool of the precise diagnosis. Choriocarcinoma has a very good prognosis even in advanced stages, since it is very chemosensitive.

CONCLUSION

The current trend of the treatment of ectopic pregnancy by conservative surgery requires adequate monitoring of βhCG and careful examination of pathologic specimens to avoid misdiagnosis of ectopic gestational trophoblastic disease.     

Mediastinal bronchogenic cyst associated with high serum level of CA19-9 —A surgical case report—

We reported a case of mediastinal bronchogenic cyst in a patient with a high serum level of CA19-9. The patient, a 41-year-old man, presented with a complaint of persistent fever. Chest X-ray examination, computed tomograp-hy and magnetic resonance imaging showed a subcarinal mass shadow which was diagnosed preoperatively as a bronchogenic cyst. The serum level of CA19-9 was 73 U/ml. The cyst was partially removed via right thoracotomy. Histopathological findings were compatible with bronchogenic cyst. The CA19-9 level in the specimen was 134000 U/ml. The serum level of CA19-9 decreased to normal postoperatively. The postoperative course was uneventful.     

Comparison of clinical and pathological characteristics in incidentally detected and suspected renal carcinoma.

In a study of the clinical and pathological characteristics of incidentally detected and suspected renal carcinoma, we reviewed the manner of presentation, serum immunosuppressive acidic protein (IAP), tumour stage and size in 112 consecutive patients with renal carcinoma who were diagnosed clinically and surgically between 1980 and 1989. The results showed an increase in the proportion of incidentally diagnosed cases. The routine use of radiological imaging, especially ultrasound and computed tomography (CT), has led to tumours being diagnosed earlier than when IAP is used as a tumour marker in patients with incidentally detected renal carcinoma. Tumours were lower stage and smaller in patients with incidentally detected renal carcinoma than in patients in whom the diagnosis was suspected.     

Virilization with adrenal myelolipoma, adrenal hyperplasia, and fibroadenoma of breast

Adrenal myelolipoma is a rare, benign and usually hormonally inactive tumour. We report a case of a young female who presented with hormonally active tumour causing virilization and associated type-2 Diabetes mellitus. Laparoscopic adrenalectomy was done after CT finding of a large left adrenal mass that was producing large amounts of androgens. Adrenal myelolipoma with cortical hyperplasia was diagnosed on histopathological examination. Her diabetes progressively regressed after the removal of tumour and glucose tolerance remained normal up to 1 year of follow-up after surgery and there was no recurrence of tumour. She also had a lump in her breast which proved to be a fibroadenoma. We report this case due to its rarity, multiplicity of tumours and adrenal cortical hyperplasia-presenting as an unusual cause of severe virilization.     

Perspectives of tumour markers in gastrointestinal malignancies — an overview

There is an increasing incidence of GI cancers as per the Cancer Registry Data. In such a situation, it is essential to evaluate the patient by standard investigational tools like clinical examination and endoscopy which help in establishing the diagnosis. Determination of tumour markers is useful not only in diagnosis and prognosis of cancer but also monitoring of cancer treatment. Tumour markers in GI oncology include oncofoetal proteins, hormones, enzymes and cancer antigens. Recent advances include application of tumour marker level determination combined with newer radiological and functional imaging such as FDG PET — CT.     

Giant asymptomatic borderline ovarian tumor in a patient suffering from choledocholithiasis and cholangitis

Borderline tumors account for about 15% of all ovarian epithelial tumors and are usually diagnosed only when they reach a significant size causing abdominal pain or distension. Clinical, sonographic and Doppler examinations, as well as tumor marker levels cannot detect this type of ovarian tumor with certainty. The definitive diagnosis can only be established by a histopathological examination. We present a case of a 58-year-old patient operated on at our clinic for asymptomatic borderline ovarian tumor. Prior to admission, the patient underwent a medical check-up at the surgery department, where she was diagnosed with choledocholithiasis, and, consequently, the need for urgent surgical treatment for calculosis was excluded. In the presented case the ovarian tumor was revealed owing to the occurrence of choledocholithiasis and cholangitis. The choledocholithiasis and cholangitis, which contributed to the accurate diagnosis of the tumor, were at the same time some of the possible reasons for misleading diagnosis and therapy complications in our patient's case.     

An association of mucocele and carcinoid tumour of the appendix

The carcinoid tumour of the appendix and the mucocele are entities rather infrequent in children and are normally diagnosed in the course of an appendicectomy that is, in most of the cases, curative. The association of both processes is unusual. The authors present a case of carcinoid tumour of the appendix associated to mucocele in a male, aged 10 patient, who underwent an appendicectomy by suspicion of an acute appendicitis. The histologic study confirmed the presence of a mucocele of the appendix associated to a carcinoid tumour with a 0,7 cm diameter. The serum serotonin and chromogranin A assessment was normal, and the TAC and colonoscopic examination resulted in no meaningful findings. The appendicectomy itself was curative, deeming it the appropiated treatment in tumours under 2 cm diameter.     

Progressive acquired lymphangioma: report of a case and review of the literature

We present 2-year-old patient with a allopecia lesions in scalp, and clinique diagnostic of Cutis Aplasia. The anatomopathologic study have diagnosed the lesions as Acquired Progressive Lymphangioma (APL). Is a rare vascular tumour that has a tendency to appear in childhood an to progress slowly over the years. It could present as a solitary erythematous macule or plaque and a simple excision is usually curative. Our patient is the youngest reported in the literature.     

Brown tumour: presenting symptom of primary hyperparathyroidism

The skeletal lesions of primary hyperparathyroidism, including brown tumour, are rare nowadays, with the practice of checking serum calcium levels leading to an earlier diagnosis of hyperparathyroidism. Clinical, laboratory, radiographic and histological investigations can lead to a correct diagnosis. Treatment of brown tumour focuses on the hyperparathyroidism, and is usually followed by a regression of the brown tumour. The diagnosis of hyperparathyroidism and brown tumour should be considered in patients with hypercalcaemia and an osteolytic expansive bone lesion. We present a patient where a brown tumour of the mandible was the presenting symptom of primary hyperparathyroidism.     

Clinical relevance of radioimmunologic determination of prostate specific antigen in prostate cancer

To recognize progression of an inoperable prostatic cancer we use clinical parameters and the prostate specific phosphatase. The prostate specific antigen (PSA) is a new, sensitive and specific laboratory tumor marker. With 363 specimens of patients without prostatic cancer we defined for the normal range of this serum parameter. In 98 men with histologically proven prostatic cancers we investigated for the clinical relevancy of the serum level of PSA. We believe, that measurement of serum PSA give important information for clinical management of prostatic cancer.     

Serum acid phosphatase as a tumour marker in giant cell tumour of bone

The serum acid phosphatase value was examined in nine patients with giant cell tumour of bone. Five showed a high level of acid phosphatase, which fell to within normal limits after surgery. Although the remaining four patients showed a normal acid phosphatase level before surgery, the postoperative acid phosphatase level was lower than the preoperative level in each case. Therefore, it is strongly suggested that serum acid phosphatase is a useful tumour marker in diagnosing giant cell tumour of bone as well as in evaluating the efficacy of treatment. Received: 9 March 2000