Testicular choriocarcinoma is a relatively rare malignancy with a highly aggressive nature. Timely diagnosis and treatment can help prolong the survival of patients and even cure them. This case reports a 29-year-old male who presented to the clinic for a month with epigastric pain without complaints of discomfort in the reproductive system. On examination, only a massive mass of approximately 9*10 cm could be palpated in the upper abdomen. When asked about his previous history, the patient only described a history of a right inguinal hernia that had been repaired 12 years earlier without knowing that a testicular descending fixation had been performed at the same time (we only found out afterward by asking his parents). The admission diagnosis was considered the retroperitoneal tumor, which was found to have metastasized to the liver and lungs after the completion of relevant tests. We then performed a CT-guided puncture biopsy of the lung tissue. The biopsy pathology suggested only a tiny heterotypic cell mass, and metastatic cancer was considered. As the symptoms of tumor compression gradually worsened, we nevertheless performed surgical treatment (retroperitoneal tumor resection + partial duodenal resection + enteroanastomosis). The postoperative pathology was choriocarcinoma. It was at this point that we pursued the patient's medical history in detail and, at the same time, performed a testicular ultrasound which revealed a substantial occupation of the right testicle. The diagnosis of testicular choriocarcinoma was finally considered (without pathological confirmation). We wanted to start salvage chemotherapy as soon as possible after surgery. However, the patient's postoperative condition was poor, with rapid progression of hepatopulmonary metastases and gradually increased thyrotoxicosis, and we started salvage chemotherapy (EP regimen: etoposide and cisplatin) on postoperative day 12. However, the patient was forced to stop due to a severe chemotherapy reaction and eventually died of respiratory and cardiac arrest in hospital. For men presenting with a large retroperitoneal mass without reproductive system-related complaints, a detailed history of the inguinal testicle should still be inquired with a detailed physical examination. Meanwhile, laboratory and image tests should be performed to rule out the possibility of a genital tumor to avoid a missed diagnosis that could lead to delayed treatment.
Background: Copper-induced death (cuproptosis) is copper-dependent regulated cell death, which is different from known death mechanisms and is dependent on mitochondrial respiration. However, its effect on breast cancer (BRCA) is unclear. Objective: The objective of this study is to explore the important clinical significance of cuproptosis genes and to provide a new idea for guiding the personalized immunotherapy strategy of BRCA patients. Materials and Method: We collected cuproptosis genes from published work. The gene alteration, differential expression, and prognostic value of cuproptosis genes were explored in BRCA based on TCGA database. We identified two subtypes (clusters A and B) by performing unsupervised clustering. The difference between two clusters was deeply explored, including clinical features, differential expressed genes (DEGs), pathways, and immune cell infiltration. Based on the DEGs between two clusters, a cuproptosis score was constructed and its predictive capability for overall survival of BRCA patients was validated. Results and Discussion: Patients with high cuproptosis score have worse survival status, with an increased infiltration level of most immune cells. Further analysis suggested that BRCA patients with high cuproptosis score may be sensitive to immune checkpoint inhibitor (ICI) treatment. Conclusion: Our findings may improve our understanding of cuproptosis in BRCA and may distinguish patients suitable for ICI treatment. conclusion: Our findings may improve our understanding of cuproptosis in BRCA and may distinguish patients suitable for ICI treatment.
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