A Nonseminomatous Germ Cell Tumor Presenting as a Mixed Cryoglobulinemic Vasculitis
Background. Mixed cryoglobulinemia syndrome (MCS) is a rare entity with a variety of causes but has not been associated with testicular germ cell tumors. We present here a case of a patient with a nonseminomatous germ cell tumor (NSGCT) presenting as a type III mixed cryoglobulinemic vasculitis. Cas...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Hindawi Limited
2022-01-01
|
| Series: | Case Reports in Oncological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2022/3326761 |
| _version_ | 1797832766509809664 |
|---|---|
| author | Gabriel Cojuc-Konigsberg Isabel Natera-Comte Blanca E. López Graciano Luis Gerardo Mosqueda López José Alonso Ávila-Rojo Braulio Martínez Juan C. Ramírez-Sandoval |
| author_facet | Gabriel Cojuc-Konigsberg Isabel Natera-Comte Blanca E. López Graciano Luis Gerardo Mosqueda López José Alonso Ávila-Rojo Braulio Martínez Juan C. Ramírez-Sandoval |
| author_sort | Gabriel Cojuc-Konigsberg |
| collection | DOAJ |
| description | Background. Mixed cryoglobulinemia syndrome (MCS) is a rare entity with a variety of causes but has not been associated with testicular germ cell tumors. We present here a case of a patient with a nonseminomatous germ cell tumor (NSGCT) presenting as a type III mixed cryoglobulinemic vasculitis. Case Presentation. A 58-year-old male exhibited typical clinical features of vasculitis, including weakness, fatigue, palpable purpura, multiple mononeuropathy, and a low C4 level. An MCS diagnosis was confirmed by the presence of cryoglobulins (6%) with polyclonal IgM and IgG components and biopsy proven leukocytoclastic vasculitis. Concomitantly, a stage IIIC (TxNxM1bS1) germ tumor with marked elevation of serum beta-human chorionic gonadotropin (2764 mUI/mL) was diagnosed. An aggressive treatment was needed, including methylprednisolone pulses, plasmapheresis, rituximab, followed by orchiectomy, and chemotherapy (bleomycin/etoposide/cisplatin). After tumor resection and treatment, cryoglobulins decrease to 0%, suggesting a paraneoplastic origin of the vasculitis. Conclusion. To the best of our knowledge, this is the first case of MCS possibly attributable to a NSGCT. This case further elaborates on the presentation of mixed cryoglobulinemia vasculitis and adds to the published literature on the topic. |
| first_indexed | 2024-04-09T14:14:07Z |
| format | Article |
| id | doaj.art-69dee1c8950940d98262bffb7335b4da |
| institution | Directory Open Access Journal |
| issn | 2090-6714 |
| language | English |
| last_indexed | 2024-04-09T14:14:07Z |
| publishDate | 2022-01-01 |
| publisher | Hindawi Limited |
| record_format | Article |
| series | Case Reports in Oncological Medicine |
| spelling | doaj.art-69dee1c8950940d98262bffb7335b4da2023-05-06T00:00:01ZengHindawi LimitedCase Reports in Oncological Medicine2090-67142022-01-01202210.1155/2022/3326761A Nonseminomatous Germ Cell Tumor Presenting as a Mixed Cryoglobulinemic VasculitisGabriel Cojuc-Konigsberg0Isabel Natera-Comte1Blanca E. López Graciano2Luis Gerardo Mosqueda López3José Alonso Ávila-Rojo4Braulio Martínez5Juan C. Ramírez-Sandoval6Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránBackground. Mixed cryoglobulinemia syndrome (MCS) is a rare entity with a variety of causes but has not been associated with testicular germ cell tumors. We present here a case of a patient with a nonseminomatous germ cell tumor (NSGCT) presenting as a type III mixed cryoglobulinemic vasculitis. Case Presentation. A 58-year-old male exhibited typical clinical features of vasculitis, including weakness, fatigue, palpable purpura, multiple mononeuropathy, and a low C4 level. An MCS diagnosis was confirmed by the presence of cryoglobulins (6%) with polyclonal IgM and IgG components and biopsy proven leukocytoclastic vasculitis. Concomitantly, a stage IIIC (TxNxM1bS1) germ tumor with marked elevation of serum beta-human chorionic gonadotropin (2764 mUI/mL) was diagnosed. An aggressive treatment was needed, including methylprednisolone pulses, plasmapheresis, rituximab, followed by orchiectomy, and chemotherapy (bleomycin/etoposide/cisplatin). After tumor resection and treatment, cryoglobulins decrease to 0%, suggesting a paraneoplastic origin of the vasculitis. Conclusion. To the best of our knowledge, this is the first case of MCS possibly attributable to a NSGCT. This case further elaborates on the presentation of mixed cryoglobulinemia vasculitis and adds to the published literature on the topic.http://dx.doi.org/10.1155/2022/3326761 |
| spellingShingle | Gabriel Cojuc-Konigsberg Isabel Natera-Comte Blanca E. López Graciano Luis Gerardo Mosqueda López José Alonso Ávila-Rojo Braulio Martínez Juan C. Ramírez-Sandoval A Nonseminomatous Germ Cell Tumor Presenting as a Mixed Cryoglobulinemic Vasculitis Case Reports in Oncological Medicine |
| title | A Nonseminomatous Germ Cell Tumor Presenting as a Mixed Cryoglobulinemic Vasculitis |
| title_full | A Nonseminomatous Germ Cell Tumor Presenting as a Mixed Cryoglobulinemic Vasculitis |
| title_fullStr | A Nonseminomatous Germ Cell Tumor Presenting as a Mixed Cryoglobulinemic Vasculitis |
| title_full_unstemmed | A Nonseminomatous Germ Cell Tumor Presenting as a Mixed Cryoglobulinemic Vasculitis |
| title_short | A Nonseminomatous Germ Cell Tumor Presenting as a Mixed Cryoglobulinemic Vasculitis |
| title_sort | nonseminomatous germ cell tumor presenting as a mixed cryoglobulinemic vasculitis |
| url | http://dx.doi.org/10.1155/2022/3326761 |
| work_keys_str_mv | AT gabrielcojuckonigsberg anonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT isabelnateracomte anonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT blancaelopezgraciano anonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT luisgerardomosquedalopez anonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT josealonsoavilarojo anonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT brauliomartinez anonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT juancramirezsandoval anonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT gabrielcojuckonigsberg nonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT isabelnateracomte nonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT blancaelopezgraciano nonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT luisgerardomosquedalopez nonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT josealonsoavilarojo nonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT brauliomartinez nonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis AT juancramirezsandoval nonseminomatousgermcelltumorpresentingasamixedcryoglobulinemicvasculitis |