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Hip Dysplasia

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.

Lacunar Syndromes – Clear Clinical Overview Lacunar syndromes are a group of distinct neurological presentations caused by small deep infarcts (lacunes) in the brain. These infarcts result from occlusion of small penetrating arteries, most commonly due to chronic hypertension, but also diabetes and smoking. Unlike large strokes, lacunar strokes do not involve the cerebral cortex, which explains their characteristic pattern of symptoms. The Five Classical Lacunar Syndromes 1. Pure Motor Stroke (Pure Motor Hemiparesis) Most common lacunar syndrome Weakness or paralysis of the face, arm, and leg on one side No sensory loss Common lesion sites: Posterior limb of the internal capsule Basis pontis 2. Pure Sensory Stroke Numbness, tingling, or altered sensation on one side of the body No motor weakness Typically involves the thalamus (especially the ventral posterolateral nucleus) 3. Ataxic Hemiparesis Combination of: Ipsilateral weakness Poor coordination (ataxia), especially affecting gait Often appears as “clumsy walking” Common lesion sites: Pons Internal capsule Corona radiata 4. Dysarthria–Clumsy Hand Syndrome Slurred speech (dysarthria) Clumsiness and poor fine motor control of the hand Facial weakness may be present Lesions usually located in: Pons Internal capsule 5. Mixed Sensorimotor Stroke Motor weakness and sensory loss on the same side of the body Often due to lesions involving both: Thalamus (sensory) Internal capsule (motor) Causes & Pathophysiology Lacunar strokes result from disease of small penetrating arteries: 🔹 Main mechanisms Occlusion of a single small artery Lipohyalinosis Vessel wall thickening and degeneration from chronic hypertension Microatheroma Small atherosclerotic plaque within the penetrating artery 🔹 Resulting lesion Lacune: A small, fluid-filled cavity in brain tissue Size: 3–15 mm Common Brain Locations Involved Internal capsule Thalamus Pons Basal ganglia Corona radiata These are deep brain structures, which explains the symptom pattern. Diagnosis & Key Clinical Characteristics Diagnosis Clinical syndrome recognition is essential MRI (especially DWI) confirms diagnosis by showing a small deep infarct Key distinguishing features ✅ Deficits confined to motor and/or sensory pathways ❌ No cortical signs, such as: Aphasia Neglect Visual field loss Seizures This absence of cortical features helps differentiate lacunar syndromes from larger territorial strokes. Clinical Importance Lacunar strokes often have better short-term survival, but: Recurrent lacunes can lead to vascular dementia Associated with chronic small vessel disease Strongly linked to long-standing uncontrolled hypertension