House S07EP20 “Changes”
The last day of Micro lecture for the Spring semester, and one more new episode of House! On tonight’s episode we find that we cannot put the House/Cuddy relationship behind us; it creeps out of the basement, like a bad case of mildew. Here’s the recap from fox.com:
After suffering partial paralysis while searching for a long-lost love, lottery winner Cyrus Harry (guest star Donal Logue) is brought to for treatment by House and the team. Cuddy’s mother (guest star Candace Bergen) threatens to sue the hospital for malpractice, jeopardizing both Cuddy and House’s medical licenses. Chase and Foreman make a bet that tests each one in different ways.
Not a huge amount to go from that description, but I will watch it because Candace Bergen is a comic genius, and Donal Logue is pretty funny too. With a vague neurological issue (“partial paralysis,”) I’m going to guess some sort of viral encephalitis, perhaps due to a mosquito-borne infection. Let’s check back again Monday evening!
I’m going to try something different today, and write this while doing the exam review, and in the form of Twitter tweets. We’ll see how it goes.
Grounded For Life dude falls down after not catching up with an old girlfriend.
MRI is clean; time to search his workshop.
Uh, oh; Cuddy’s Mom is mad over her ‘mistreatment’ from earlier in the season.
Paralyzed dude eats food from cans; botulism?
Cuddy’s Mom is suing the hospital, preventing House from diagnosing the case.
And we hit viral encephalitis at 8:16; treat with I.V. acyclovir! Way too early, must be something else.
Doing some more imaging, and finding multiple tumors which appear to be unrelated. That’s interesting!
The tumors have all shrank over the past 10 minutes, while we’ve been working the ‘A’ plot with Cuddy’s mom.
Now we suspect amyloidosis; biopsy the GI to verify, chemo to treat.
Final diagnosis: a teratoma. Primitive cells have taken on brain cell characteristics, which have triggered an antibody response.
So here we are. Teratomas are tumors that are thought to be present at birth, but small ones are typically not found until late in life. Teratomas found in women are generally benign, while in men they are typically malignant. The cells in teratomas can take on the characteristics of many kinds of cells. In the case of the patient on House this week, these tumor cells then metastasized and began to grow in many location. This promoted an antibody response to the teratoma cells, which also reacted with normal brain tissue causing the neurological problems starting out the episode.
The incidence of teratomas diagnosed in adulthood is relatively low, however the numbers of found in newborns is higher. They are generally treated by surgery to resect the tumor, which is successful as teratomas are encapsulated tumors. If the tumor metastasizes (moves from the primary location to a distal location,) resection will be followed up with chemotherapy. These tumors are very responsive to treatment, and Wikipedia indicates that the 5 year survival rate for many forms of the cancer is around 90%. Because of their origin from primitive fetal-derived tissue, there is interest in basic research to further characterize these tumors, as they have some of the properties of embryonic stem cells, but lack to potential to grow into a person.
We’ll call this episode plausible, with a reasonable diagnosis in the end.