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Hospital de Clínicas de Porto Alegre, Porto Alegre RS, BrazilDepartment of Pharmaceutical Sciences, Universidade Estadual de Ponta Grossa, Ponta Grossa PR, Brazil, 84030-900
A 42-year-old man presented to the clinic with generalized lymphadenopathy, weight
loss, and right upper quadrant abdominal pain for 1 month. He was an active smoker
and crack cocaine user without comorbidities. Physical examination revealed hepatomegaly
and cervical, axillary, and inguinal lymphadenopathy; testicular examination was unremarkable.
The patient was admitted for further investigations. Serum levels of beta-HCG (human
chorionic gonadotropin) (180 mIU/mL) and lactate dehydrogenase (LDH) (685 U/L) were
increased, and chest and abdominal CT scans showed disseminated lesions compatible
with metastases in the lungs (Figure 1A), liver (Figure 1B), pancreas, spleen, kidneys, vertebrae, and lymph nodes. Eventually, the patient
developed acute respiratory failure due to pulmonary metastases, thus requiring intubation
and mechanical ventilation. Despite the best supportive care, he was deteriorating
rapidly. Biopsy of a cervical lymph node, done before clinical deterioration, showed
highly mitotic, undifferentiated malignancy with positive staining for cytokeratin
7 and placental alkaline phosphatase. Despite that, the pathology report was deemed
inconclusive.
Figure 1CT scans at diagnosis. (A) CT of the chest, coronal image. (B) CT of the abdomen,
cross-sectional image.
NP searched the literature and wrote the first draft. All authors reviewed and edited the first draft and are responsible for the integrity of the data and the accuracy of the manuscript. All authors approved the final version. Written consent for publication was obtained from the patient.
