Clinical Reasoning: A 25-year-old man with headaches and collapse

From the Department of Neurology (S.S.), Beth Israel Deaconess Medical Center
Neurology (Impact Factor: 8.29). 05/2013; 80(20):e211-4. DOI: 10.1212/WNL.0b013e318292a30c
Source: PubMed


A 25-year-old Caucasian man with a history of headaches presented to the emergency room for witnessed collapse. The emergency room physician who initially evaluated the patient reported that the physical examination had normal results.

Full-text preview

Available from:
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To analyze the management and prognosis of primary choriocarcinoma (PCC) in male patients. Methods The clinical records of males with PCC who were treated at Peking Union Medical College Hospital between 1990 and 2012 were analyzed retrospectively. The literature regarding this clinical condition was also reviewed. Results The median survival interval of the 13 patients treated at Peking Union Medical College Hospital was 54 months (range, 6–115 months), and the 1- and 3-year survival rates were 53.8% and 43.1%, respectively. All patients were treated with surgery; 12 were treated with combined chemotherapy. After including 100 cases found in the literature, for a total of 113 patients, the median survival interval was 10 months (range, 6.4–13.6 months). The testis was the most common primary site (36.2%). Most patients (70.9%) had metastatic lesions at diagnosis. Univariate and multivariate analyses revealed that longer median overall survival was significantly associated with patient age <34 years old (48 months vs 10 months, odds ratio [OR] =0.47, P=0.029), the presence of other histological components (54 months vs 11 months, OR =0.54, P=0.011), and combined chemotherapy and surgical treatments (14 months vs 2.5 months, OR =0.18, P=0.002). Conclusion PCC is an extremely rare disease among men, and its prognosis is much worse than that of gestational choriocarcinoma. The complete resection of the primary site and metastases followed by chemotherapy seems to provide patients with the best chance at survival. Furthermore, additional chemotherapy cycles might facilitate better progress.
    Full-text · Article · Jun 2014 · OncoTargets and Therapy
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Feb 2015 · Current Oncology Reports