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Favero D, Oing C, Seidel C, Rescigno P, Catalano F, Cremante M, Rebuzzi SE, Gatto F, Rosti G, Ferone D, Fornarini G, Cocchiara F. Hyperthyroidism in non-seminomatous testicular germ cell tumors: two case reports and literature review. Front Oncol 2024; 14:1338438. [PMID: 38601761 PMCID: PMC11004277 DOI: 10.3389/fonc.2024.1338438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
Background Human chorionic gonadotropin (hCG)-induced hyperthyroidism is a rare paraneoplastic syndrome observed in non-seminomatous testicular germ cell tumors, due to a cross-reaction between the β-subunit of hCG with the thyroid-stimulating hormone receptor. The precise prevalence of this paraneoplastic phenomenon is unclear as, in the majority of cases, hyperthyroidism remains subclinical. Case presentation Here, we present two cases of advanced metastatic non-seminomatous testicular germ cell tumors where patients exhibited signs and symptoms of thyrotoxicosis at primary diagnosis due to excessive serum β-hCG elevation, with complete remission of symptomatology after the start of oncological treatments and no signs of relapse at the time of publication of this report. Additionally, we provide a comprehensive review of the existing literature concerning this uncommon occurrence. Conclusion Despite being a rare event, the presence of hyperthyroidism or thyrotoxicosis without clear etiology in a young man should lead to consider less frequent causes such as testicular tumors. Even if patients typically have mild symptoms that resolve after chemotherapy, in rare cases, it can be a life-threatening condition that requires prompt recognition and specific intervention.
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Affiliation(s)
- Diletta Favero
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Christoph Oing
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
- Mildred Scheel Cancer Career Centre HaTriCS4, University Cancer Centre Hamburg, University Medical Centre Eppendorf, Hamburg, Germany
| | - Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Centre Eppendorf, Hamburg, Germany
| | - Pasquale Rescigno
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
- Candiolo Cancer Institute Fondazione del Piemonte per l’Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
| | - Fabio Catalano
- Medical Oncology Unit 1, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Malvina Cremante
- Medical Oncology Unit 1, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova, Italy
| | - Federico Gatto
- Endocrinology Unit, Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Giovanni Rosti
- Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (Di.M.I.), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Cocchiara
- Endocrinology Unit, Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
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A Nonseminomatous Germ Cell Tumor Presenting as a Mixed Cryoglobulinemic Vasculitis. Case Rep Oncol Med 2022; 2022:3326761. [PMID: 36589386 PMCID: PMC9803560 DOI: 10.1155/2022/3326761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/25/2022] Open
Abstract
Background Mixed cryoglobulinemia syndrome (MCS) is a rare entity with a variety of causes but has not been associated with testicular germ cell tumors. We present here a case of a patient with a nonseminomatous germ cell tumor (NSGCT) presenting as a type III mixed cryoglobulinemic vasculitis. Case Presentation. A 58-year-old male exhibited typical clinical features of vasculitis, including weakness, fatigue, palpable purpura, multiple mononeuropathy, and a low C4 level. An MCS diagnosis was confirmed by the presence of cryoglobulins (6%) with polyclonal IgM and IgG components and biopsy proven leukocytoclastic vasculitis. Concomitantly, a stage IIIC (TxNxM1bS1) germ tumor with marked elevation of serum beta-human chorionic gonadotropin (2764 mUI/mL) was diagnosed. An aggressive treatment was needed, including methylprednisolone pulses, plasmapheresis, rituximab, followed by orchiectomy, and chemotherapy (bleomycin/etoposide/cisplatin). After tumor resection and treatment, cryoglobulins decrease to 0%, suggesting a paraneoplastic origin of the vasculitis. Conclusion To the best of our knowledge, this is the first case of MCS possibly attributable to a NSGCT. This case further elaborates on the presentation of mixed cryoglobulinemia vasculitis and adds to the published literature on the topic.
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Rückert JC, Elsner A, Andreas MN. [Mediastinal Tumors]. Zentralbl Chir 2022; 147:99-120. [PMID: 35235970 DOI: 10.1055/a-1674-0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
If mediastinal tumours cause symptoms these are related to their anatomical localization or a paraneoplastic syndrome. The differential diagnosis is based on the clinical situation with finding the lesion, and, furthermore, taking into account the age and sex of the patient, and the mediastinal compartment where the lesion is located. Cross-sectional radiographic diagnostic is essential for defining the therapeutic strategy. The anterior mediastinum is dominated by thymic tumours, mediastinal lymphomas, germ cell tumours and ectopic mediastinal poiters. The middle mediastinal compartment is the most frequent place of mediastinal cystic tumours, whereas the posterior mediastinum is the domain of neurogenic tumours. For selected cases a tissue biopsy is required. Surgery is the mainstay for most mediastinal tumours. Median sternotomy is the most frequent conventional surgical technique while minimally invasive surgery with thoracoscopic and above all robot assisted operation techniques are increasingly frequent. Combined chemotherapy and modern radiotherapy are essential components of the comprehensive treatment for mediastinal tumours.
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Affiliation(s)
- Jens-Carsten Rückert
- Chirurgische Klinik Campus Charité Mitte, Charité Universitätsmedizin, Berlin, Deutschland
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Chivukula KK, Toro-Tobón D, Motazedi B, Goyal R. Thyroid storm as an early presentation of hCG-producing metastatic choriocarcinoma: a case report and review of the literature. BMJ Case Rep 2021; 14:e242868. [PMID: 34580125 PMCID: PMC8477237 DOI: 10.1136/bcr-2021-242868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Abstract
Human chorionic gonadotropin (hCG)-induced hyperthyroidism has been previously reported as a rare paraneoplastic syndrome in non-seminomatous germ cell tumours and usually presents with mild symptoms or subclinical thyrotoxicosis. We present a case of a young adult man who consulted with abdominal pain, nausea and emesis. On admission, he was found to be tachycardic, febrile, anxious and with icteric sclera and tenderness to palpation in the right upper abdomen. A right scrotal mass was also noted. Initial studies revealed transaminitis, hyperbilirubinaemia, suppressed thyroid-stimulating hormone and elevated free T4. Scrotal biopsy confirmed diagnosis of testicular choriocarcinoma with an elevated hCG level of 6074 mIU/mL, which was corrected to 6 760 713 mIU/mL when reassessed with dilution. The clinical scenario reflected hCG-induced thyrotoxicosis concerning for thyroid storm. Euthyroid state was restored after initiation of chemotherapy and a short course of methimazole. Unfortunately, the patient passed away due to progression of his malignant disease. This case suggests that when choriocarcinoma is suspected, the use of iodinated contrast agents should be limited to avoid precipitation of thyroid storm or worsening of hCG-induced hyperthyroidism. Moreover, if the clinical picture does not support a primary aetiology of hyperthyroidism and hCG is not concordantly elevated, reassessment of hCG by dilution should be considered as hCG assays are subject to prozone effect.
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Affiliation(s)
| | | | | | - Rachna Goyal
- MedStar Georgetown University Hospital, Washington, DC, USA
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Aftan MK, Badrawi N, Abdulghaffar S, Abedzadeh AA, albastaki U, Raman LG, Alzeena EFG. Pure testicular choriocarcinoma Cannonball metastases as a presenting imaging feature: A case report and a review of literature. Radiol Case Rep 2021; 16:923-928. [PMID: 33613805 PMCID: PMC7881168 DOI: 10.1016/j.radcr.2021.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/03/2023] Open
Abstract
Pure testicular choriocarcinoma is an extremely rare subtype of nonseminomatous germ cell tumor, accounting for less than 1% of all germ cell tumors and only 0.19% of all testicular tumors. It is a highly aggressive malignant tumor with early multiorgan metastasis and poor prognosis. We present a case of 23-year-old male presented to the hospital with mild hemoptysis which was thought as a sequela of his past COVID-19 pneumonia infection, however; chest radiograph showed multiple rounded cannonball opacities seen throughout both lungs raising the suspicion of metastatic deposits to the lungs. During physical examination, left testicular painless swelling was noted leading to an ultrasound of the scrotum which revealed a left intratesticular infiltrative, heterogeneous mass. Tumor markers, including beta-human chorionic gonadotropin, lactate dehydrogenase and alpha fetoprotein were extremely high. Computed tomography scan of the brain, chest, abdomen, and pelvis showed hemorrhagic metastatic deposits to the brain, chest, and left para-aortic lymph nodes. The patient underwent radical orchiectomy and histopathology reports confirmed the diagnosis of pure testicular choriocarcinoma.
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Affiliation(s)
- Mohanad Kareem Aftan
- Dubai Health Authority, PO Box 4545, Dubai, United Arab Emirates,Corresponding author.
| | - Noor Badrawi
- Dubai Health Authority, PO Box 4545, Dubai, United Arab Emirates
| | | | | | - Usama albastaki
- Dubai Health Authority, PO Box 4545, Dubai, United Arab Emirates
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Sharma A, Stan MN. Thyrotoxicosis: Diagnosis and Management. Mayo Clin Proc 2019; 94:1048-1064. [PMID: 30922695 DOI: 10.1016/j.mayocp.2018.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/25/2018] [Accepted: 10/22/2018] [Indexed: 12/20/2022]
Abstract
Thyrotoxicosis is the clinical manifestation of excess thyroid hormone action at the tissue level due to inappropriately high circulating thyroid hormone concentrations. Hyperthyroidism, a subset of thyrotoxicosis, refers specifically to excess thyroid hormone synthesis and secretion by the thyroid gland. We performed a review of the literature on these topics utilizing published data in PubMed and MEDLINE. In this review, we discuss the more common etiologies of thyrotoxicosis, focusing on the current approach to diagnosis and management, new trends in those directions, and potential upcoming changes in the field.
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Affiliation(s)
- Anu Sharma
- Division of Endocrinology, Metabolism and Diabetes, University of Utah School of Medicine, Salt Lake City, UT
| | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
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7
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Steggink LC, van Beek AP, Boer H, Meijer C, Lubberts S, Oosting SF, de Jong IJ, van Ginkel RJ, Lefrandt JD, Gietema JA, Nuver J. Insulin-like factor 3, luteinizing hormone and testosterone in testicular cancer patients: effects of β-hCG and cancer treatment. Andrology 2019; 7:441-448. [DOI: 10.1111/andr.12581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/01/2018] [Accepted: 11/30/2018] [Indexed: 01/09/2023]
Affiliation(s)
- L. C. Steggink
- Department of Medical Oncology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - A. P. van Beek
- Division of Endocrinology; Department of Internal Medicine; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - H. Boer
- Department of Medical Oncology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - C. Meijer
- Department of Medical Oncology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - S. Lubberts
- Department of Medical Oncology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - S. F. Oosting
- Department of Medical Oncology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - I. J. de Jong
- Department of Urology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - R. J. van Ginkel
- Division of Surgical Oncology; Department of Surgery; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - J. D. Lefrandt
- Division of Vascular Medicine; Department of Internal Medicine; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - J. A. Gietema
- Department of Medical Oncology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - J. Nuver
- Department of Medical Oncology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
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8
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Rejlekova K, Cursano MC, De Giorgi U, Mego M. Severe Complications in Testicular Germ Cell Tumors: The Choriocarcinoma Syndrome. Front Endocrinol (Lausanne) 2019; 10:218. [PMID: 31031704 PMCID: PMC6474390 DOI: 10.3389/fendo.2019.00218] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/18/2019] [Indexed: 02/02/2023] Open
Abstract
Testicular germ cell tumors (TGCTs) represent the most common solid tumor in young men and is a model of curable cancer. The effectiveness of cisplatin-based chemotherapy secures more than 95% of patients' 5-years survival rate. However, some high-risk patients with a very advanced disease develop choriocarcinoma syndrome (CS) connected with acute respiratory failure with poor prognosis and high mortality rate shortly after beginning systemic chemotherapy. CS was first described as a syndrome with hemorrhage from metastatic sites in patients with TGCTs with significantly high choriogonadotropin level. Acute hemorrhage to lung metastases is typical, but hemorrhage can occur from any metastatic site. Patognomic of choriocarcinoma cells is an invasion of small blood vessels within CS. The incidence of CS in patients with TGCTs are not well-defined and can vary across the world. To date, there are a few case reports and small retrospective series reporting a connection between systemic chemotherapy and the development of CS in metastatic TGCTs. CS is known to be triggered by massive tumor cell lysis as a result of chemotherapy and cytokine release, aggravated with alveolar hemorrhage. This can lead to a consecutive superinfection, furthered with neutropenia after chemotherapy, acute respiratory distress syndrome, rising to systemic inflammatory response, resulting in multiorgan failure and death. A reasonably effective approach in patients with extensive disease could be a shortened course of chemotherapy as well as a reduction of dosage in induction chemotherapy before full-dose chemotherapeutical regimen; however, current data regarding optimal treatment approach are limited. Patients' referral to tertiary centers and the administration of induction chemotherapy in an intensive care unit setting could further improve the treatment outcome.
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Affiliation(s)
- Katarina Rejlekova
- 2nd Department of Oncology, Faculty of Medicine, National Cancer Institute, Comenius University, Bratislava, Slovakia
| | | | - Ugo De Giorgi
- Medical Oncology Department, Instituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, National Cancer Institute, Comenius University, Bratislava, Slovakia
- *Correspondence: Michal Mego
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Gu H, Sui S, Cui X, Han B, Zhang C, Qi M, Li C, Liu Z. Thyroid carcinoma producing β-human chorionic gonadotropin shows different clinical behavior. Pathol Int 2018; 68:207-213. [PMID: 29446856 DOI: 10.1111/pin.12639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Haiyan Gu
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of Pathology; The Affiliated Hospital of Qingdao University; 16#, Jiangsu Road Qingdao Shandong 266003 PR China
| | - Shaofeng Sui
- Institute of Occupational and Environmental Health; Shandong Center for Disease Control and Prevention; 16992#, Jingshi Road Jinan Shandong 250014 PR China
| | - Xiujie Cui
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of pathogeny biology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
| | - Bo Han
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of Pathology; Shandong University Qilu Hospital; 107#, Wenhua Xi Road Jinan Shandong 250012 PR China
| | - Chunyan Zhang
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of Pathology; The Affiliated Hospital of Jining Medical College; 89#, Guhuai Road Jining Shandong 272029 PR China
| | - Mei Qi
- Department of Pathology; Shandong University Qilu Hospital; 107#, Wenhua Xi Road Jinan Shandong 250012 PR China
| | - Congcong Li
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of Obstetrics and Gynecology; Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200120 PR China
| | - Zhiyan Liu
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of Pathology; Shandong University Qilu Hospital; 107#, Wenhua Xi Road Jinan Shandong 250012 PR China
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Abstract
This article reviews those pathologic lesions which are associated with clinical and/or biochemical hyperthyroidism. Beginning with the descriptive pathology of classical Graves' disease and the less common toxic nodular goiter and hyper-functioning thyroid nodules, this paper describes the effects of non-thyroidal hormones, glandular function (including pituitary and hypothalamic lesions), ectopic production of thyroid stimulating proteins by non-thyroidal neoplasms, exogenous drug reactions causing hyper-function and finally conditions associated with a mechanic- destructive cause of hyperthyroidism.
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Dao A, Jabir H, Taleb A, Benchakroun N, Bouchbika Z, Nezha T, Jouhadi H, Sahraoui S, Benider A. Lung adenocarcinoma with thyroid metastasis: a case report. BMC Res Notes 2017; 10:130. [PMID: 28327204 PMCID: PMC5360081 DOI: 10.1186/s13104-017-2449-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 03/11/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The metastases of a primary lung cancer over the thyroid gland are extremely rare. We report on an unusual presentation of thyroid metastasis of lung cancer in order to improve the management of similar cases. CASE PRESENTATION Three years ago, a Moroccan male 59-year-old was admitted for dyspnea, dry cough, and chest pain. He had smoked about 30 cigarette packs a year. Clinical examination revealed a right thyroid nodule. Chest and neck computed tomography (CT) scan showed a proximal left tumor in contact with the pulmonary artery and revealed a suspected nodule in the right lobe of the thyroid with homolateral neck node. Transbronchial biopsy was performed and pathological examination revealed adenocarcinoma of the lung and positive for thyroid transcription factor. Other explorations carried out, such as brain CT, bone scan and abdominal ultrasound were normal. After a repeated negative fine needle aspiration biopsy of the suspected nodule of the right lobe of the thyroid, we performed total thyroidectomy with neck dissection. An anatomopathologic exam revealed a tubulopapillary adenocarcinoma poorly differentiated. An Immunohistochemistry showed positive tumor cells with TTF1 and cytokeratin (CK) 7 but negative cells with thyroglobulin and CK20. Thus, the pulmonary tumor was classified stage IV. Chemotherapy based on the combination of cisplatin and etoposide was conducted along with supportive care. The tumor grew up with brain metastases after three cycles of chemotherapy. Unfortunately, the patient died 2 months after despite brain radiotherapy. CONCLUSION We presented a medical case of a patient with thyroid metastasis resulting from a pulmonary adenocarcinoma which has rapidly evolved to brain metastases. The prognosis was pejorative in our clinical case (5 months after admission).
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Affiliation(s)
- A. Dao
- Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - H. Jabir
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd, Casablanca, Morocco
| | - A. Taleb
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd, Casablanca, Morocco
| | - N. Benchakroun
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd, Casablanca, Morocco
| | - Z. Bouchbika
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd, Casablanca, Morocco
| | - T. Nezha
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd, Casablanca, Morocco
| | - H. Jouhadi
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd, Casablanca, Morocco
| | - S. Sahraoui
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd, Casablanca, Morocco
| | - A. Benider
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd, Casablanca, Morocco
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Chatzitomaris A, Hoermann R, Midgley JE, Hering S, Urban A, Dietrich B, Abood A, Klein HH, Dietrich JW. Thyroid Allostasis-Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming. Front Endocrinol (Lausanne) 2017; 8:163. [PMID: 28775711 PMCID: PMC5517413 DOI: 10.3389/fendo.2017.00163] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/27/2017] [Indexed: 12/21/2022] Open
Abstract
The hypothalamus-pituitary-thyroid feedback control is a dynamic, adaptive system. In situations of illness and deprivation of energy representing type 1 allostasis, the stress response operates to alter both its set point and peripheral transfer parameters. In contrast, type 2 allostatic load, typically effective in psychosocial stress, pregnancy, metabolic syndrome, and adaptation to cold, produces a nearly opposite phenotype of predictive plasticity. The non-thyroidal illness syndrome (NTIS) or thyroid allostasis in critical illness, tumors, uremia, and starvation (TACITUS), commonly observed in hospitalized patients, displays a historically well-studied pattern of allostatic thyroid response. This is characterized by decreased total and free thyroid hormone concentrations and varying levels of thyroid-stimulating hormone (TSH) ranging from decreased (in severe cases) to normal or even elevated (mainly in the recovery phase) TSH concentrations. An acute versus chronic stage (wasting syndrome) of TACITUS can be discerned. The two types differ in molecular mechanisms and prognosis. The acute adaptation of thyroid hormone metabolism to critical illness may prove beneficial to the organism, whereas the far more complex molecular alterations associated with chronic illness frequently lead to allostatic overload. The latter is associated with poor outcome, independently of the underlying disease. Adaptive responses of thyroid homeostasis extend to alterations in thyroid hormone concentrations during fetal life, periods of weight gain or loss, thermoregulation, physical exercise, and psychiatric diseases. The various forms of thyroid allostasis pose serious problems in differential diagnosis of thyroid disease. This review article provides an overview of physiological mechanisms as well as major diagnostic and therapeutic implications of thyroid allostasis under a variety of developmental and straining conditions.
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Affiliation(s)
- Apostolos Chatzitomaris
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- *Correspondence: Apostolos Chatzitomaris,
| | - Rudolf Hoermann
- Private Consultancy, Research and Development, Yandina, QLD, Australia
| | | | - Steffen Hering
- Department for Internal Medicine, Cardiology, Endocrinology, Diabetes and Medical Intensive Care Medicine, Krankenhaus Bietigheim-Vaihingen, Bietigheim-Bissingen, Germany
| | - Aline Urban
- Department for Anesthesiology, Intensive Care and Palliative Medicine, Eastern Allgäu-Kaufbeuren Hospitals, Kaufbeuren, Germany
| | | | - Assjana Abood
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Harald H. Klein
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
| | - Johannes W. Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
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Sotello D, Rivas AM, Test VJ, Lado-Abeal J. Choriocarcinoma presenting with thyrotoxicosis. Proc AMIA Symp 2016; 29:42-3. [PMID: 26722165 PMCID: PMC4677850 DOI: 10.1080/08998280.2016.11929353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We describe a 26-year-old man with metastatic choriocarcinoma who presented with hyperthyroidism associated with elevated β-human chorionic gonadotropin (B-HCG) and respiratory failure secondary to diffuse lung metastasis. After the first cycle of chemotherapy, the concentration of B-HCG dramatically decreased and the patient became euthyroid, allowing us to discontinue antithyroid medications. The patient's hyperthyroidism was caused by stimulation of the thyroid gland by high B-HCG levels, as shown by the marked improvement of the patient's thyroid function panel after chemotherapy.
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Affiliation(s)
- David Sotello
- Department of Internal Medicine (Sotello, Rivas), Division of Pulmonary/Critical Care Medicine (Test), and Division of Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
| | - Ana Marcella Rivas
- Department of Internal Medicine (Sotello, Rivas), Division of Pulmonary/Critical Care Medicine (Test), and Division of Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
| | - Victor J Test
- Department of Internal Medicine (Sotello, Rivas), Division of Pulmonary/Critical Care Medicine (Test), and Division of Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
| | - Joaquin Lado-Abeal
- Department of Internal Medicine (Sotello, Rivas), Division of Pulmonary/Critical Care Medicine (Test), and Division of Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
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Pallais JC, McInnis M, Saylor PJ, Wu RI. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 38-2015. A 21-Year-Old Man with Fatigue and Weight Loss. N Engl J Med 2015; 373:2358-69. [PMID: 26650156 DOI: 10.1056/nejmcpc1506821] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Abstract
Testicular germ cell tumors represent the most common malignancy among young men. While 5-year overall survival and cure for this population is greater than 95%, choriocarcinoma is an aggressive subtype of this disease with far worse prognosis--5-year survival for choriocarcinoma is less than 80%. In order to be able to treat these patients appropriately, a provider must recognize characteristic features of choriocarcinoma including elevated human chorionic gonadotropin in a young man with testicular mass; the astute clinician should also know the signs and symptoms of choriocarcinoma syndrome, characterized by bleeding from metastatic sites, which represents a medical emergency and is associated with high morbidity and mortality. Treatment should be directed towards a goal of tumor marker normalization, and patients with refractory disease should be considered for advanced therapies and clinical trials. Choriocarcinoma is a unique and aggressive germ cell malignancy, and these patients require early aggressive treatment to improve their chance of survival.
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Heda P, Cushing G. Testicular choriocarcinoma presenting as hyperthyroidism. Am J Med 2013; 126:e1-2. [PMID: 24157290 DOI: 10.1016/j.amjmed.2013.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 06/26/2013] [Accepted: 07/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Pallavi Heda
- Lahey Clinic, Tufts University, Burlington, Mass.
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17
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Implication from thyroid function decreasing during chemotherapy in breast cancer patients: chemosensitization role of triiodothyronine. BMC Cancer 2013; 13:334. [PMID: 23829347 PMCID: PMC3717040 DOI: 10.1186/1471-2407-13-334] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 06/30/2013] [Indexed: 12/18/2022] Open
Abstract
Background Thyroid hormones have been shown to regulate breast cancer cells growth, the absence or reduction of thyroid hormones in cells could provoke a proliferation arrest in G0-G1 or weak mitochondrial activity, which makes cells insensitive to therapies for cancers through transforming into low metabolism status. This biological phenomenon may help explain why treatment efficacy and prognosis vary among breast cancer patients having hypothyroid, hyperthyroid and normal function. Nevertheless, the abnormal thyroid function in breast cancer patients has been considered being mainly caused by thyroid diseases, few studied influence of chemotherapy on thyroid function and whether its alteration during chemotherapy can influence the respose to chemotherapy is still unclear. So, we aimed to find the alterations of thyroid function and non-thyroidal illness syndrome (NTIS) prevalence druing chemotherapy in breast cancer patients, and investigate the influence of thyroid hormones on chemotherapeutic efficacy. Methods Thyroid hormones and NTIS prevalence at initial diagnosis and during chemotherapy were analyzed in 685 breast diseases patients (369 breast cancer, 316 breast benign lesions). The influence of thyroid hormones on chemotherapeutic efficacy was evaluated by chemosensitization test, to compare chemotherapeutic efficacy between breast cancer cells with chemotherapeutics plus triiodothyronine (T3) and chemotherapeutics only. Results In breast cancer, NTIS prevalence at the initial diagnosis was higher and increased during chemotherapy, but declined before the next chemotherapeutic course. Thyroid hormones decreased signigicantly during chemotherapy. T3 can enhance the chemosensitivity of MCF-7 to 5-Fu and taxol, with progression from G0-G1 phase to S phase. The similar chemosensitization role of T3 were found in MDA-MB-231. We compared chemotherapeutic efficacy among groups with different usage modes of T3, finding pretreatment with lower dose of T3, using higher dose of T3 together with 5-Fu or during chemotherapy with 5-Fu were all available to achieve chemosensitization, but pretreatment with lower dose of T3 until the end of chemotherapy may be a safer and more efficient therapy. Conclusions Taken together, thyroid hormones decreasing during chemotherapy was found in lots of breast cancer patients. On the other hand, thyroid hormones can enhance the chemotherapeutic efficacy through gatherring tumor cells in actively proliferating stage, which may provide a new adjuvant therapy for breast cancer in furture, especially for those have hypothyroidism during chemotherapy.
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18
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Choriocarcinoma syndrome: a case report and a literature review. Case Rep Oncol Med 2013; 2013:697251. [PMID: 23819084 PMCID: PMC3681292 DOI: 10.1155/2013/697251] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/08/2013] [Indexed: 11/17/2022] Open
Abstract
A 35-year-old Qatari man presented to our hospital with a 4-month history of mild abdominal pain, weight loss, and jaundice. He was found to have central intra-abdominal mass and a single testis in the scrotum. His investigations showed cholestatic jaundice and very high level of β-HCG (1131379 IU/L). CT scans of the chest and abdomen showed a huge pelvic-abdominal mass with extensive retroperitoneal lymphadenopathy, in addition to liver and lung metastases. CT-guided Tru-Cut biopsy of the mass showed mixed germ cell tumor. Chemotherapy was refused by the patient and his family. In the following days, the patient bled from his liver metastases leading to hemorrhagic shock, hemorrhage from metastatic sites of choriocarcinoma containing tumors is named choriocarcinoma syndrome. He was transferred to the medical intensive care unit, where he was intubated and resuscitated. Embolization of the right hepatic artery was done, but failed to control the bleeding, which continued with development of disseminated intravascular coagulopathy and a severe abdominal compartment syndrome, and eventually the patient died.
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McCracken EJ, Johnston PC, Lindsay JR, Mulholland C, McAleer JJA, Black RN. Testicular choriocarcinoma: an unusual case of paraneoplastic thyrotoxicosis. QJM 2012; 105:675-7. [PMID: 21652536 DOI: 10.1093/qjmed/hcr084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E J McCracken
- Department of Endocrinology and Diabetes, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, UK
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Abstract
Hyperthyroidism describes the sustained increase in thyroid hormone biosynthesis and secretion by a thyroid gland with increased metabolism. Although the use of radioiodine scanning serves as a useful surrogate that may help characterize the cause of thyrotoxicosis, it only indirectly addresses the underlying physiologic mechanism driving the increase in serum thyroid hormones. In this article, thyrotoxic states are divided into increased or decreased thyroid metabolic function. In addition to the diagnosis, clinical presentation, and treatment of the various causes of hyperthyroidism, a section on functional imaging and appropriate laboratory testing is included.
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Affiliation(s)
- Stuart C Seigel
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Croom KF, Dhillon S. Bevacizumab: a review of its use in combination with paclitaxel or capecitabine as first-line therapy for HER2-negative metastatic breast cancer. Drugs 2012; 71:2213-29. [PMID: 22035518 DOI: 10.2165/11207720-000000000-00000] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Bevacizumab (Avastin™) is a humanized monoclonal antibody directed against vascular endothelial growth factor. In patients with human epidermal growth factor receptor type 2 (HER2)-negative metastatic breast cancer, bevacizumab is indicated as first-line therapy in combination with paclitaxel, or in combination with capecitabine when treatment with other chemotherapy options, including taxanes or anthracyclines, is not considered appropriate. This article reviews the efficacy and tolerability of these combination therapies in the first-line treatment of patients with metastatic breast cancer, and summarizes the pharmacological properties of bevacizumab. In randomized, controlled, phase III trials in patients with predominantly HER2-negative metastatic or locally recurrent breast cancer, the addition of bevacizumab to paclitaxel or capecitabine significantly prolonged progression-free survival (PFS; investigator assessment) by a median of 5.9 and 2.9 months, respectively, relative to paclitaxel or capecitabine alone. It also significantly increased the objective response rate, but not overall survival. Independent reviews of data supported the results of the primary analyses of investigator-assessed PFS. However, as the efficacy of bevacizumab in combination with capecitabine appears to be less than that of other available options, it should be used only if treatment with other chemotherapy options are not considered appropriate. The addition of bevacizumab to paclitaxel had no significant adverse effects on health-related quality of life. Efficacy data from two routine clinical practice studies were generally consistent with those from the phase III trials. Bevacizumab had generally acceptable tolerability when administered in combination with paclitaxel or capecitabine as first-line therapy in these studies, and adverse events were consistent with the known tolerability profiles of the individual agents. The most common adverse events associated with bevacizumab combination therapy in phase III trials were sensory neuropathy and grade ≥3 hypertension, occurring more frequently with combination therapy than with chemotherapy alone. Potentially life-threatening events, such as venous thromboembolism, gastrointestinal perforation, arterial thromboembolism, haemorrhage and left ventricular dysfunction, occurred in ≤5% of patients receiving combination therapy in these trials. In conclusion, bevacizumab administered in combination with paclitaxel, or in combination with capecitabine if other chemotherapy regimens are not appropriate, may be considered as an option for the first-line treatment of patients with HER2-negative metastatic breast cancer.
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Kohler S, Tschopp O, Jacky E, Schmid C. Paraneoplastic hyperthyroidism. BMJ Case Rep 2011; 2011:bcr.04.2011.4163. [PMID: 22688478 DOI: 10.1136/bcr.04.2011.4163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors describe a 31-year-old male with a metastatic germ cell tumour and massively elevated human chorionic gonadotrophin (HCG) levels who presented with hyperthyroidism. As HCG is structurally closely related to thyroid stimulating hormone (TSH), it can activate the TSH receptor; grossly elevated levels may result in hyperthyroidism. After initiation of chemotherapy, HCG levels decreased and hyperthyroidism resolved.
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Affiliation(s)
- Sibylle Kohler
- Endocrinology Department, University Hospital Zurich, Zurich, Switzerland.
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Current World Literature. Curr Opin Oncol 2011; 23:303-10. [DOI: 10.1097/cco.0b013e328346cbfa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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