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. 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

Oral health in older adults with cancer

Cancer is a disease of older adults, with 60% of cancer diagnoses and 70% of cancer deaths occurring in individuals &ge; 65 years. Normal oral aging may transition to disease in the presence of one or more potential modifiers, such as a new oncological diagnosis or a new treatment. Oral conditions in patients with cancer cause significant morbidity. Previous work suggests that oral conditions are neither elicited/assessed/reassessed nor well-managed or investigated in older patients. However, frequently reported oral conditions in patients undergoing cancer therapy include xerostomia, dysgeusia, candidiasis, mucositis, and dental caries. Some oncological treatments such as hematopoietic stem cell transplant or chemotherapy/radiotherapy for head and neck cancers entail higher risks of oral complications. No specific recommendations in the case of older adults with cancer-associated oral conditions are available. Treatment recommendations are based on low levels of evidence and/or evidence extrapolated from younger patients with cancer.</p