Disorders of Sex Development and Malignant Germ Cell Tumors
October 14th 2020Key points: Patients with disorders of sex development (DSDs) are at an increased risk of malignant germ cell tumors (GCTs). In adulthood, the partial form of androgen insensitivity syndrome confers the greatest risk of developing malignant GCTs. Gonadoblastoma is the most common gonadal GCT arising in patients with DSDs. Despite being a benign neoplasm, it can undergo malignant transformation in up to 60% of patients with a DSD. Oncologic treatment in patients with disorders of sex development and malignant GCTs does not differ from the standard treatment for testicular GCTs. Treatment of patients with DSDs requires a multidisciplinary team, including a psychiatric, genetic, and reproductive assessment as well as the involvement of an ethics committee. An early diagnosis of DSDs is crucial to avoid the development of potentially serious complications in adulthood.
Diffuse Hepatic Infiltration by Metastatic Melanoma
July 16th 2019Melanoma of the skin is the 19th most common malignant neoplasm worldwide, with 287,723 new cases estimated for 2018 and metastatic melanoma accounting for 4% of all new cases. In recent years, the prognosis of this stage has undergone a dramatic transformation with the advent of immunotherapy and BRAF/MEK targeted therapy.
Multiple Myeloma With Extramedullary Disease: A Challenging Clinical Dilemma
April 15th 2019A 39-year-old woman with no significant medical history presented to the emergency department with progressive diffuse abdominal pain, involuntary weight loss, anemic syndrome, and limitation of mobility. What is the best treatment course to follow?
Is This Patient With Metastatic Bladder Cancer a Candidate for Second-Line Immunotherapy Treatment?
February 15th 2018A 67-year-old man, a former smoker, presented with gross hematuria. A CT urogram showed a bladder tumor in the anterior wall and multiple enlarged retroperitoneal lymph nodes. Two vertebral metastases were seen on a bone scan. He underwent a transurethral resection of the bladder, and the pathology report revealed muscle-invasive urothelial carcinoma.
Man With Recurring Chordoma and Progressive Disease Despite Radiotherapy and Radical Resection
February 16th 2016A 60-year-old man presented with lower limb claudication and a painful mass on his left buttock. Physical examination revealed a firm round mass, fixed to deep planes. A biopsy was performed and revealed a chordoma.
Man With Locally Advanced, High-Risk Prostate Cancer Asks About Adding Chemotherapy to His Treatment
January 15th 2016A 55-year-old Hispanic male presents with a family history of gastric cancer in one sibling and prostate cancer in an older brother. CT performed in March 2015 for IMT surveillance showed a heterogeneous prostate with local invasion involving the bladder, seminal vesicles, and perirectal fat.
A Patient With Newly Diagnosed Metastatic Type 2 Papillary Renal Cell Carcinoma
November 16th 2015A 42-year-old man presented with increasing right hip pain that limited his ability to walk. Magnetic resonance imaging (MRI) revealed a right lytic acetabular lesion. Further work-up included a computed tomography (CT) scan, which revealed an 8-cm left kidney tumor.
What Next? Choosing Second-Line Therapy in Progressive Renal Cell Carcinoma
September 15th 2014A 71-year-old woman presented with back pain and was incidentally found to have a left upper pole renal mass. She underwent left open partial nephrectomy; the pathology results revealed a 2.2-cm clear-cell renal cell carcinoma (RCC) with negative margins and a Fuhrman nuclear grade of 2.