open access

Vol 15, No 6 (2019)
Case report
Published online: 2020-01-10
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hCG-secreting malignancies — diagnostic pitfalls

Wojciech Michalski, Grażyna M Poniatowska, Joanna G Jońska-Gmyrek, Karol E. Nietupski, Anna Z. Cencelewicz, Andrzej Mróz, Witold Gerke, Agnieszka Chreptowicz, Tomasz Demkow, Paweł J Wiechno
DOI: 10.5603/OCP.2019.0040
·
Oncol Clin Pract 2019;15(6):331-335.

open access

Vol 15, No 6 (2019)
CASE REPORT
Published online: 2020-01-10

Abstract

We present a case of a 34-year-old male patient referred to our Uro-oncology Department with a suspicion of a metastatic germ cell tumour, owing to enlarged left testicle and elevated b-hCG concentration (39 mIU/mL). Impaired performance status caused by extensive pulmonary and liver metastases, accompanied by significant lymphadenopathy, necessitated prompt management. However, a testicular tumour was excluded on ultrasound imaging; a hydrocele only was found. The b-hCG concentration was not increasing (37 mIU/mL). We found a diagnosis of an extragonadal germ cell tumour doubtful, and a liver biopsy was performed. Due to the patient’s quick deterioration, we decided to commence pre-phase chemotherapy with cisplatin and etoposide, which resulted in a significant clinical improvement. The pathological examination, along with immunoassays, revealed undifferentiated cholangiocarcinoma, and the patient continued chemotherapy with a biliary tract cancer regimen, i.e. cisplatin and gemcitabine. Unfortunately, the clinical response was short-lived; the disease progressed, the patient was offered best supportive care and died two months after the diagnosis. The case underpins the literature review with respect to differential diagnosis of an elevated hCG concentration. In particular, we discuss ectopic secretion in non-trophoblastic and non-germinal malignancies and the causes of false positive assays.

Abstract

We present a case of a 34-year-old male patient referred to our Uro-oncology Department with a suspicion of a metastatic germ cell tumour, owing to enlarged left testicle and elevated b-hCG concentration (39 mIU/mL). Impaired performance status caused by extensive pulmonary and liver metastases, accompanied by significant lymphadenopathy, necessitated prompt management. However, a testicular tumour was excluded on ultrasound imaging; a hydrocele only was found. The b-hCG concentration was not increasing (37 mIU/mL). We found a diagnosis of an extragonadal germ cell tumour doubtful, and a liver biopsy was performed. Due to the patient’s quick deterioration, we decided to commence pre-phase chemotherapy with cisplatin and etoposide, which resulted in a significant clinical improvement. The pathological examination, along with immunoassays, revealed undifferentiated cholangiocarcinoma, and the patient continued chemotherapy with a biliary tract cancer regimen, i.e. cisplatin and gemcitabine. Unfortunately, the clinical response was short-lived; the disease progressed, the patient was offered best supportive care and died two months after the diagnosis. The case underpins the literature review with respect to differential diagnosis of an elevated hCG concentration. In particular, we discuss ectopic secretion in non-trophoblastic and non-germinal malignancies and the causes of false positive assays.

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Keywords

human chorionic gonadotropin (hCG); germ cell tumour; paraneoplastic syndrome

About this article
Title

hCG-secreting malignancies — diagnostic pitfalls

Journal

Oncology in Clinical Practice

Issue

Vol 15, No 6 (2019)

Article type

Case report

Pages

331-335

Published online

2020-01-10

DOI

10.5603/OCP.2019.0040

Bibliographic record

Oncol Clin Pract 2019;15(6):331-335.

Keywords

human chorionic gonadotropin (hCG)
germ cell tumour
paraneoplastic syndrome

Authors

Wojciech Michalski
Grażyna M Poniatowska
Joanna G Jońska-Gmyrek
Karol E. Nietupski
Anna Z. Cencelewicz
Andrzej Mróz
Witold Gerke
Agnieszka Chreptowicz
Tomasz Demkow
Paweł J Wiechno

References (30)
  1. Sisinni L, Landriscina M. The Role of Human Chorionic Gonadotropin as Tumor Marker: Biochemical and Clinical Aspects. Adv Exp Med Biol. 2015; 867: 159–176.
  2. Oldenburg J, Fosså SD, Nuver J, et al. ESMO Guidelines Working Group. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24 Suppl 6: vi125–vi132.
  3. Honecker F, Aparicio J, Berney D, et al. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol. 2018; 29(8): 1658–1686.
  4. Lazopoulos A, Krimiotis D, Schizas NC, et al. Galactorrhea, mastodynia and gynecomastia as the first manifestation of lung adenocarcinoma. A case report. Respir Med Case Rep. 2019; 26: 146–149.
  5. Cirit Koçer B, Erdoğan Y, Akıncı Özyürek B, et al. β-HCG secretion by a non-small cell lung cancer: a case report. Tuberk Toraks. 2016; 64(1): 69–72.
  6. Kugasia IR, Alkayem M, Patel JB. A rare case of β-hCG production by a solitary fibrous tumor of the pleura. Am J Case Rep. 2014; 15: 518–522.
  7. Ben Kridis W, Ben Hassena R, Charfi S, et al. Gastric signet-ring cell carcinoma with hypersecretion of β-Human chorionic gonadotropin and review of the literature. Exp Oncol. 2018; 40(2): 149–151.
  8. Leostic A, Tran PL, Fagot H, et al. Elevated human chorionic gonadotrophin without pregnancy: A case of gallbladder carcinoma. J Gynecol Obstet Hum Reprod. 2018; 47(3): 141–143.
  9. Louhimo J, Carpelan-Holmström M, Alfthan H, et al. Serum HCG beta, CA 72-4 and CEA are independent prognostic factors in colorectal cancer. Int J Cancer. 2002; 101(6): 545–548.
  10. Reisenbichler ES, Krontiras H, Hameed O. Beta-human chorionic gonadotropin production associated with phyllodes tumor of the breast: an unusual paraneoplastic phenomenon. Breast J. 2009; 15(5): 527–530.
  11. Mustafa A, Bozdag Z, Tepe NB, et al. An unexpected reason for elevated human chorionic gonadotropin in a young woman. Cervical squamous carcinoma. Saudi Med J. 2016; 37(8): 905–907.
  12. Wagner V, Winn H, Newtson A, et al. hCG production by mucinous adenocarcinoma of the ovary in a reproductive aged woman. Gynecol Oncol Rep. 2018; 26: 102–104.
  13. Grenache DG, Moller KA, Groben PM. Endometrial adenocarcinoma associated with elevated serum concentrations of the free beta subunit of human chorionic gonadotropin. Am J Clin Pathol. 2004; 121(5): 748–753.
  14. Ahmed M, Kanji A, Begum T. Gynaecomastia: an unusual presenting symptom of bladder cancer. BMJ Case Rep. 2015; 2015.
  15. Gupta AK, Charlton A, Prelog K, et al. β-HCG Elevation in Wilms Tumor: An Uncommon Presentation. Pediatr Blood Cancer. 2016; 63(6): 1105–1106.
  16. Gu H, Sui S, Cui X, et al. Thyroid carcinoma producing β-human chorionic gonadotropin shows different clinical behavior. Pathol Int. 2018; 68(4): 207–213.
  17. Alikhan M, Koshy A, Hyjek E, et al. Discrepant serum and urine β-hCG results due to production of β-hCG by a cribriform-morular variant of thyroid papillary carcinoma. Clin Chim Acta. 2015; 438: 181–185.
  18. Tuy BE, Obafemi AA, Beebe KS, et al. Case report: elevated serum beta human chorionic gonadotropin in a woman with osteosarcoma. Clin Orthop Relat Res. 2008; 466(4): 997–1001.
  19. Maryamchik E, Lyapichev KA, Halliday B, et al. Dedifferentiated Liposarcoma With Rhabdomyosarcomatous Differentiation Producing HCG: A Case Report of a Diagnostic Pitfall. Int J Surg Pathol. 2018; 26(5): 448–452.
  20. Morris CD, Hameed MR, Agaram NP, et al. Elevated β-hCG associated with aggressive Osteoblastoma. Skeletal Radiol. 2017; 46(9): 1187–1192.
  21. Lawless ME, Jour G, Hoch BL, et al. Beta-human chorionic gonadotropin expression in recurrent and metastatic giant cell tumors of bone: a potential mimicker of germ cell tumor. Int J Surg Pathol. 2014; 22(7): 617–622.
  22. Lempiäinen A, Hotakainen K, Blomqvist C, et al. Increased human chorionic gonadotropin due to hypogonadism after treatment of a testicular seminoma. Clin Chem. 2007; 53(8): 1560–1561.
  23. Cole LA, Sasaki Y, Muller CY. Normal production of human chorionic gonadotropin in menopause. N Engl J Med. 2007; 356(11): 1184–1186.
  24. Ballieux BE, Weijl NI, Gelderblom H, et al. False-positive serum human chorionic gonadotropin (HCG) in a male patient with a malignant germ cell tumor of the testis: a case report and review of the literature. Oncologist. 2008; 13(11): 1149–1154.
  25. Aherne NJ, Small CA, McVey GP, et al. Abnormal hCG levels in a patient with treated stage I seminoma: a diagnostic dilemma. World J Surg Oncol. 2008; 6: 68.
  26. Beck SDW, Patel MI, Sheinfeld J. Tumor marker levels in post-chemotherapy cystic masses: clinical implications for patients with germ cell tumors. J Urol. 2004; 171(1): 168–171.
  27. Inoue M, Koga F, Kawakami S, et al. False tumor marker surge evoked by peripheral blood stem cell transplantation. Oncologist. 2008; 13(5): 526–529.
  28. Patel KK, Gronowski AM. Heterophile antibody interference in qualitative urine/serum hCG devices: Case report. Clin Biochem. 2016; 49(9): 729–731.
  29. Garnick MB. Spurious rise in human chorionic gonadotropin induced by marihuana in patients with testicular cancer. N Engl J Med. 1980; 303(20): 1177.
  30. Braunstein GD, Thompson R, Gross S, et al. Marijuana use does not spuriously elevate serum human chorionic gonadotropin levels. Urology. 1985; 25(6): 605–606.

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