Clinical Communication to the Editor|Articles in Press

A treatment-naive cancer patient in critical condition

      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 1:
      Figure 1CT scans at diagnosis. (A) CT of the chest, coronal image. (B) CT of the abdomen, cross-sectional image.

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        • Michaelson MD.
        Serum tumor markers in testicular germ cell tumors.
        in: Lerner S.P. Shah & S. UpToDate. Available from. 2022 (Accessed Feb 3, 2023)
        • Reiswich V
        • Gorbokon N
        • Luebke AM
        • et al.
        Pattern of placental alkaline phosphatase (PLAP) expression in human tumors: a tissue microarray study on 12,381 tumors.
        J Pathol Clin Res. 2021; 7: 577-589
        • Hainsworth JD
        • Greco FA.
        Poorly differentiated cancer from an unknown primary site.
        in: Canelos G.P. Shah & S. UpToDate. 2023 (Available from:) (Accessed Feb 3, 2023)
        • Schmoll HJ.
        Extragonadal germ cell tumors.
        Ann Oncol. 2002; 13: 265-272
        • Morelli F
        • Tozzi L
        • Setola P
        • Bisceglia M
        • Barbini VR
        • Maiello E.
        Postchemotherapy residual masses in germ cell tumor patients: our experience.
        Ann Oncol. 2006; 17: vii132-vii136
        • Williams SD
        • Birch R
        • Einhorn LH
        • Irwin L
        • Greco FA
        • Loehrer PJ.
        Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide.
        N Engl J Med. 1987; 316: 1435-1440
        • Hinton S
        • Catalano PJ
        • Einhorn LH
        • et al.
        Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial.
        Cancer. 2003; 97: 1869-1875