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Raynaud's syndrome

Esophageal varices are abnormally enlarged veins in the esophagus (the tube connecting the throat and stomach). They most often develop in people with advanced liver disease, especially cirrhosis. Why esophageal varices form When liver scarring blocks normal blood flow, pressure builds in the portal vein (portal hypertension). Blood is forced into smaller veins—such as those in the lower esophagus—that aren’t built to handle high pressure. These veins enlarge, can leak, and may rupture, causing life-threatening bleeding. Symptoms Varices usually don’t cause symptoms unless they bleed. Signs of bleeding include: Vomiting blood Black, tarry or bloody stools Lightheadedness or fainting from blood loss Loss of consciousness in severe cases People with liver disease may also have: Jaundice (yellow skin/eyes) Easy bruising or bleeding Ascites (fluid buildup in the abdomen) Emergency: Bloody vomit or black/bloody stools require immediate medical care (call 911). Causes Cirrhosis from hepatitis, alcohol-related liver disease, fatty liver disease, or primary biliary cholangitis Blood clots in the portal or splenic vein Schistosomiasis (parasitic infection in certain regions) Risk factors for bleeding High portal vein pressure Large varices Red streaks or spots seen on endoscopy Severe cirrhosis or liver failure Continued alcohol use Previous variceal bleeding Complications Massive bleeding, shock, and death High risk of recurrent bleeding after a first episode Prevention & management Varices themselves can’t always be prevented, but bleeding risk can be reduced: Nonselective beta blockers (e.g., propranolol, nadolol) to lower portal pressure Endoscopic screening for people with cirrhosis; band ligation for high-risk varices Avoid alcohol Healthy diet and weight management Protect the liver: safe sex, avoid needle sharing, get vaccinated for hepatitis A and B Use chemicals and medicines carefully If you have liver disease, ask your healthcare professional about screening and preventive treatment for esophageal varices.

Germ cells, also called gametes, are specialized cells responsible for sexual reproduction. Their name comes from the word germinate, meaning “to begin to grow.” During fetal development, germ cells migrate to specific locations and later develop into sperm in males or egg cells (ova) in females. In some cases, germ cells undergo abnormal growth and form a germ cell tumor (GCT). These tumors most commonly develop in the testicles or ovaries, but in rare cases, they can appear in other parts of the body. Germ cell tumors are rare and most often occur in adolescents and young adults between ages 15 and 30, though they can affect children and older adults as well. Types of Germ Cell Tumors Germ cell tumors can be classified by behavior, sex, and location. By Behavior Benign (non-cancerous) Malignant (cancerous) By Sex In males (testicular germ cell tumors): Seminoma Non-seminoma In females (ovarian germ cell tumors): Dysgerminoma Non-dysgerminoma Other Germ Cell Tumor Types Teratoma (benign or malignant) Choriocarcinoma Germinoma Embryonal carcinoma Endodermal sinus tumor (yolk sac tumor) Polyembryoma Mixed germ cell tumors Extragonadal Germ Cell Tumors In rare cases, germ cell tumors develop outside the ovaries or testicles. These are called extragonadal germ cell tumors and may appear in: Mediastinum (chest) Pineal region of the brain Retroperitoneum (back of the abdomen) Sacrococcygeal area (base of the spine) Causes and Risk Factors The exact cause of germ cell tumors is not fully understood, but several factors increase risk: Genetic syndromes (e.g., Turner syndrome, Klinefelter syndrome) Birth defects involving the genitals, spine, or urinary tract Cryptorchidism (undescended testicle) Age, especially males aged 15–35 and adolescent girls or young women Germ Cell Tumor Symptoms Symptoms depend on the tumor’s type and location. Ovarian Germ Cell Tumors Abdominal swelling Pelvic pain Constipation Irregular vaginal bleeding Testicular Germ Cell Tumors Testicular lump or swelling Groin pain Heaviness in the scrotum Extragonadal Germ Cell Tumors Breathing difficulty (mediastinal tumors) Urinary problems Leg weakness or neurological symptoms (spinal involvement) Diagnosis Early detection is critical. Diagnostic tests may include: Physical examination Imaging tests (ultrasound, CT scan, MRI) Blood tests (tumor markers such as AFP, β-hCG, LDH) Biopsy or surgical removal for definitive diagnosis Germ Cell Tumor Staging Staging determines how far the tumor has spread and guides treatment. Stage 1 Tumor confined to the original site Often treated with surgery alone Stage 2 Spread to nearby tissues or structures Still localized to the pelvic or regional area Stage 3 Spread to distant areas or regional lymph nodes Stage 4 Metastasis to distant organs Common sites: lungs, liver, distant lymph nodes Germ Cell Tumor Treatment Treatment is individualized based on tumor type, stage, and patient factors. Surgery First-line treatment for localized tumors May involve removal of the tumor and, if necessary, the affected ovary or testicle Fertility-sparing surgery is often possible Chemotherapy Highly effective because germ cell tumors are very chemo-sensitive Used for advanced, aggressive, or metastatic disease Radiotherapy may be added in select cases Immunotherapy Used in relapsed or chemotherapy-resistant tumors Helps the immune system target cancer cells Prognosis Germ cell tumors generally have an excellent prognosis, especially when diagnosed early. Testicular germ cell tumors: ~95% survival rate Ovarian germ cell tumors: ~93% survival rate Outcomes depend on tumor location, stage at diagnosis, response to treatment, and overall patient health.