Tumor markers in advanced nonseminomatous testicular cancer

Bosl, George J.; Lange, Paul H.; Nochomovitz, Lucien E.; Goldmann, Anne; Fraley, Elwin E.; Rosaí, Juan; Johnson, Kay; Kennedy, B. J.

doi:10.1002/1097-0142(19810201)47:3<572::aid-cncr2820470324>3.0.co;2-u

Cited by 54 publications

(10 citation statements)

References 20 publications

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“…4,5 Because the β-hCG molecule has a direct thyroid-stimulating effect, these patients may present with hyperthyroidism. 27,28 Thyroid symptoms are usually mild, even in the face of widespread choriocarcinoma, 28 but range from subtle exopthalmos to fulminant throtoxicosis.…”

Section: Endocrinementioning

confidence: 99%

“…[4][5][6] In most cases, malignant testicular tumours manifest as painless testicular masses; however, patients may also present with testicular pain secondary to bleeding or infarction in the tumour, symptoms from metastases, or symptoms from elevated levels of β-hCG. 7 Emergency physicians should be aware that testicular cancer can first present as a life-threatening disorder and that successful resuscitation may depend upon treatment of the underlying malignancy.…”

Section: Introductionmentioning

confidence: 99%

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Acute presentation of choriocarcinoma: a case study and review of the literature

Worster

Sharma

Mookadam

et al. 2002

CJEM

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We report an unusual case of a 27-year-old male with an acute presentation of choriocarcinoma. The patient presented with unstable vital signs, severe anemia and a widened arterial pulse pressure following a several day history of testicular pain. He was subsequently diagnosed as having testicular choriocarcinoma with multiple hepatic metastases and large hemorrhagic para-aortic lymph nodes. The widened pulse pressure persisted during fluid resuscitation and correction of both the anemia and hypotension, and only narrowed after the initiation of chemotherapy. A literature review indicates that metastatic testicular choriocarcinoma is a rare but aggressive malignancy that often presents with acute symptoms and signs that cause patients to seek emergency care. We summarize the reported cases of "acute" testicular choriocarcinoma presentation and briefly discuss its relationship to widened arterial pulse pressure. RÉSUMÉNous présentons un cas inhabituel de présentation aiguë d'un choriocarcinome chez un homme âgé de 27 ans. Le patient avait été reçu à l'urgence pour des signes vitaux instables, une anémie sévère et une augmentation de sa tension artérielle différentielle découlant d'une douleur testiculaire installée depuis plusieurs jours. On diagnostiqua par la suite un choriocarcinome du testicule accompagné de métastases hépatiques multiples et de ganglions para-aortiques tuméfiés et hémorragiques. L'augmentation de la tension artérielle différentielle persista au cours de la réani-mation liquidienne et de la correction de l'anémie et de l'hypotension et diminua seulement après le début de la chimiothérapie. Une revue de la littérature indique que le choriocarcinome métastatique du testicule est un cancer rare mais virulent souvent accompagné de signes et symptômes aigus qui incitent le patient à obtenir des soins d'urgence. Nous résumons les cas signalés de présentation «aiguë» de choriocarcinome du testicule et discutons brièvement de sa relation avec l'augmentation de la tension artérielle différentielle.

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Section: Endocrinementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute presentation of choriocarcinoma: a case study and review of the literature

Worster

Sharma

Mookadam

et al. 2002

CJEM

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“…92,93 Furthermore, as mentioned above, about 20 per cent of other non-trophoblastic cancers are associated with immunoreactive hCG in blood. 92,93 Furthermore, as mentioned above, about 20 per cent of other non-trophoblastic cancers are associated with immunoreactive hCG in blood.…”

Section: Hcg In Nontrophoblastic Tumours and Normal Cellsmentioning

confidence: 93%

hCG production and activity during pregnancy

Randeva

Jackson

Karteris

et al. 2001

Fet. Matern. Med. Rev.

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RT-PCR to be transcribed, albeit with different ef®ciency. The mRNA levels for each gene were determined as: b5 > b3 = b8 > b7 > b1,b2. 12 It is possible that the presence of tandemly arranged genes with identical coding sequences may have a role in the high expression of hCG in early pregnancy. STRUCTURE OF HCGThe glycoprotein hormone family are believed to share similar structural features although to date only the structure of hCG has been elucidated. Two groups independently resolved the x-ray crystallographic structure. One study used hydrogen uoride treated protein 13 and the other used recombinant selenomethionyl protein. 14 Both groups revealed almost identical structures, with residues 2 ± 111 in the b and 5 ± 89 in the a subunits traced. The failure to identify the C-terminal extension of hCGb implies that it is a poorly ordered structure. The a-and b-subunits each have remarkably similar folds. They are elongated with two adjacent loops at one end and a single long loop projecting in the opposite direction. When the heterodimer is formed the single loop of one subunit lies adjacent to the double loops of the other subunit. The b subunit of hCG has six disul®de bonds and the alpha subunit has ®ve disul®de bonds. The crystal structure revealed that the previously de®ned disul®de bonds could not all be made. 15,16 These disul®de bonds appear to play an integral role in maintaining the heterodimeric structure. At the core of the hCGa and b subunits is a cystine knot motif from which the loops project out. This motif, also found in neural growth factor, platelet derived growth factor and tumour growth factor b, is formed by two adjacent parallel strands joined by two disulphide bonds forming a ring, through which another disulphide bond is looped joining a second pair of strands. The subunit similarity is at its highest in the area of the cystine knot. With the elongated structure of hCG there is a high ratio of protein surface to hydrophobic core and the subunits associate to a large extent over the whole surface. The majority of the structural motifs in the loops are b-sheet and b-turns. In the long loop of the alpha chain there are, however, two turns of an a-helix. The loop from Cys 90 to Cys 110 in the b subunit is wrapped over and through the long loop of the a-subunit. This`seat belt' is held in place by the cystine bond b26 ± 110, which is the last disulphide to form in the folding pathway of hCG. 17,18 These structural features together with the observation that the individual subunits are inactive, have implied that the quaternary structure provided by the assembly of the alpha and beta subunits is important for hCG function. However, recent work with genetically fused alpha and beta subunits which are mutated in assembly critical residues, or in cysteine pairs forming disul®de bonds have shown that the heterodimeric con®guration is more important for assembly and secretion than for biological activity. 19,20,21 HCG is heavily glycosylated with the carbohydrate content accounting for 30% of the ...

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“…4 hCG levels above 50 000 mIU/ml are predictive of a poor prognosis. [8][9][10] Pure choriocarcinoma of the testis is the most aggressive form of GCT tumor, with a high propensity to hematogenous spread at the time of initial diagnosis. Logothetis 11 previously described a choriocarcinoma syndrome.…”

Section: Introductionmentioning

confidence: 99%