Objectives Most testicular cancer (TC) survivors have long‐term survival. However, the association between financial toxicity (FT), which is an economic side effect of cancer treatment, and the quality of life (QOL) of TC survivors is still unclear. Thus, the impact of FT on the QOL of TC survivors was examined in a multi‐institutional cross‐sectional study. Methods We recruited TC survivors from eight high‐volume institutions in Japan between January 2018 and March 2019. A total of 562 participants completed the EORTC QLQ‐C30, EORTC QLQ‐TC26 and the questionnaires on demographics, including annual income. Financial difficulty in the EORTC QLQ‐C30 and low income were used to assess financial distress (FD) and financial burden (FB), respectively. FT was defined as FD and FB. The QOL scores were compared, and a multivariate logistic regression analysis for FT was performed. Results With severe FD, TC survivors had more treatment side effects, physical limitations, and anxiety concerning employment and future. The TC survivors who reported low income were worried about their jobs and the future. The QOL of the survivors with FT exhibited high impairment, except for sexual activity. In particular, the TC survivors with FT were physically limited and anxious concerning the future. The multivariate logistic regression analysis revealed that four or more chemotherapy cycles were substantial risk factors for FT (4 cycles, odds ratio (OR) = 4.17; ≥5 cycles, OR = 6.96). Conclusions TC survivors who received multi‐cycle chemotherapy were prone to experience FT, resulting in a decline in their health‐related QOL.

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Introduction Atypical femoral fractures are atraumatic or minimally traumatic fractures and rare side effects of bone resorption inhibitors. Bone resorption inhibitors are frequently used in the treatment of prostate cancer. Case presentation A 62‐year‐old man complained of difficulty in walking and left lower limb pain. Androgen deprivation and denosumab therapy for prostate cancer‐induced bone metastasis was initiated 27 months ago. Even though the prostate‐specific antigen level did not increase, imaging studies indicated the possibility of bone metastasis. The patient underwent bone biopsy; however, no malignancy was detected. Afterward, he had a fall, causing a complete fracture in his left femur. Conclusion Atypical femoral fractures occasionally mimic typical imaging findings and outcomes of bone metastasis. This case is important for recognizing such cases.

Background: A spontaneous iliopsoas muscle hematoma is relatively rare and often associated with abnormal coagulation. Nafamostat mesilate is an anticoagulant agent that is sometimes used to treat hemodialysis patients at high risk of bleeding. Although severe drug allergy caused by nafamostat mesilate was previously reported, spontaneous iliopsoas muscle hematoma secondary to disseminated intravascular coagulation caused by nafamostat mesilate allergy has not yet been reported. Case presentation: Severe nafamostat mesilate allergy occurred in a 78-year-old male patient with a 2-year history of hemodialysis. During hospitalization, disseminated intravascular coagulation occurred followed by a progressive iliopsoas muscle hematoma a few days later. Emergent transarterial lumbar artery embolization was successfully performed. Conclusion: For dialysis patients, a detailed medical history including repeated nafamostat mesilate use and considering an allergy to nafamostat mesilate in differential diagnosis are critical. In addition to early diagnosis, when an iliopsoas hematoma occurs, early intravascular treatment is important.

Abbreviations & Acronyms AE1/3 = cytokeratin AE1/AE3 CDX2 = caudal type homeobox 2 CEA = carcinoembryonic antigen CK = cytokeratin EGFR = epidermal growth factor receptor EMT = epithelialmesenchymal transition FOLFIRI = folinic acid, 5fluorouracil and irinotecan MRI = magnetic resonance imaging PSA = prostate-specific antigen