[A patient with very high serum level of human chorionic gonadotrophin; the diagnosis is not always a germ-cell tumour]. / Een patiënt met een sterk verhoogde serumwaarde van humaan choriongonadotrofine; de diagnose is niet altijd een kiemceltumor.

A 47-year-old man, who presented with dyspnoea, gynaecomasty, and aphasia due to an extensively metastasized malignancy, was transferred to the hospital for chemotherapy as a matter of urgency. Because of his severe clinical symptoms, the widespread presence of metastases on radiological examination, and a striking increase in serum human chorionic gonadotrophin (HCG), the patient was treated with bleomycin, etoposide, and cisplatin (BEP) for a suspected metastasized germ-cell tumour. Definitive histology, however, revealed not a germ-cell tumour, but instead a large-cell undifferentiated HCG-producing carcinoma of uncertain primary origin. Using this patient's history, ectopic HCG production by malignancies is described in more detail.

Myocardial air collections as a result of infection with a gas producing strain of Escherichia coli.

Certain strains of Escherichia coli have been shown to cause gas accumulation in--for example, emphysematous pyelonephritis. This paper describes a patient with intramyocardial air collections resulting from an intramyocardial infection with gas forming E coli.

A space-occupying lesion of the skull base, masked by nasopharyngeal lymphatic tissue hypertrophy and causing cranial nerve dysfunction in an HIV-infected patient.

Patients infected with HIV are at increased risk of developing lymphoma. The lymphomas often involve extranodal sites and +/-90% are of B-cell phenotype. We describe an HIV-infected patient with unilateral multiple cranial nerve dysfunction, most likely as a result of a nasopharyngeal B-cell non-Hodgkin's lymphoma in which early histologic confirmation of the diagnosis was delayed by the simultaneous presence of nasopharyngeal lymphatic tissue hypertrophy. It is of practical importance to recognize non-Hodgkin's lymphoma as a cause of cranial nerve dysfunction and to be aware of the possibility and the implications of the simultaneous presence of nasopharyngeal lymphatic tissue hypertrophy in HIV-infected patients.