A non-pregnant woman with elevated beta-HCG: A case of para-neoplastic syndrome in ovarian cancer

Goldstein, Jennifer; Pandey, Prasamsa; Fleming, Nicole D.; Westin, Shannon N.; Piha-Paul, Sarina A.

doi:10.1016/j.gore.2016.05.004

Cited by 13 publications

(12 citation statements)

References 9 publications

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“…There have been case reports in a variety of malignancies of patients presenting with an elevated serum β-hCG. This has been documented in cancers including breast, 11 cervical, 12,13 gallbladder, 14,15 gastric, 16 head and neck, 17 lung, 18–21 ovarian, 22,23 renal cell, 24 sarcoma 25–28 and urothelial, 29 and in both male and female patients. In our case, the elevated level of β-hCG is probably attributable to ectopic excretion by the SCC tumour in the anus.…”

Section: Discussionmentioning

confidence: 91%

Elevated beta human chorionic gonadotropin in a non-pregnant female diagnosed with anal squamous cell carcinoma

Pokharel

Gilbar

Mansfield

et al. 2019

J Oncol Pharm Pract

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Introduction Elevated serum beta human chorionic gonadotrophin (β-hCG) in a female normally indicates pregnancy or possibly, gestational trophoblastic disease or ovarian germ cell tumours. Expression of β-hCG has been demonstrated in cervical and endometrial carcinoma and other non-germ cell tumours of the ovary, vulva, breast, prostate, lung, colon, oral/facial tissue and stomach. Case report We report a 43-year-old premenopausal woman with p16 positive squamous cell anal cancer. Pre-treatment urinary screening was positive for β-hCG (218 IU/L), which was confirmed on serum and expressed in the tumour. Pelvic ultrasound ruled out pregnancy. Cervical cytology detected human papilloma virus p16 infection and a potential squamous intraepithelial lesion. Management and outcome: She received definitive chemoradiation (Mitomycin/5-fluorouracil) for six weeks. β-hCG, taken four weeks post completion, had returned to normal levels (<2 IU/L). Discussion Cases of elevated serum β-hCG are documented in different cancers including breast, gastric, lung, ovarian and renal cell. In our case, the elevated β-hCG is probably ectopic excretion by the squamous cell carcinoma tumour in the anus. While this has never been reported previously in the anus, it is likely due to the documented risk of development of precancerous as well as cancerous anal and cervical lesions through human papilloma virus infection. Raised levels of β-hCG have been reported in cervical cancers. Other possible causes of β-hCG elevation were excluded. Following treatment, her β-hCG level returned to normal strengthening the hypothesis that β-hCG elevation was due to the anal carcinoma. In conclusion, unexplained ectopic secretion of β-hCG may be the first sign of a primary malignancy.

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Section: Discussionmentioning

confidence: 91%

Elevated beta human chorionic gonadotropin in a non-pregnant female diagnosed with anal squamous cell carcinoma

Pokharel

Gilbar

Mansfield

et al. 2019

J Oncol Pharm Pract

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“…To date, there has been one previously reported case of paraneoplastic hCG production in a mucinous ovarian adenocarcinoma. ( Goldstein et al, 2016 ) The elevated hCG in that case wasn't identified until the patient was enrolling onto a clinical trial for second line therapy following disease progression after surgery and chemotherapy. Whether discovered prior to surgery or prior to other cytotoxic treatment regimens, it is important to quickly be able to establish the source of hCG both to ensure the patient is not pregnant, as well as to prevent delay of treatment or unnecessarily begin treatment for ectopic pregnancy or trophoblastic disease.…”

Section: Discussionmentioning

confidence: 99%

hCG production by mucinous adenocarcinoma of the ovary in a reproductive aged woman

Wagner

Winn

Newtson

et al. 2018

Gynecologic Oncology Reports

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When elevated serum hCG is discovered during the work up of a gynecologic tumor, it is paramount to identify the source of hCG prior to initiation of treatment. Potential sources of hCG include viable intrauterine pregnancy, ectopic pregnancy, miscarriage, gestational trophoblastic disease, pituitary hCG production, phantom hCG (heterophilic antibody interference), and tumor production. Here, we present a case of elevated hCG in a young women with a large complex pelvic mass. Prior to treatment initiation, the patient underwent work up for hCG elevation, which was ultimately found to be from tumor production. Pathologic examination revealed the mass to be a mucinous adenocarcinoma of the ovary with aberrant expression of hCG, rather than the more typical hCG producing germ cell tumor. We detail the preoperative evaluation process of hCG elevation. Additionally, we discuss the role of hCG in ovarian cancer and influence on tumorigenesis and management.

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“…It has been reported that the level of serumβ-HCG is elevated in different kinds of tumors, including renal cell carcinoma, [ 15 ] cervical squamous carcinoma, [ 16 ] ovarian cancer, [ 17 ] choriocarcinoma, [ 18 ] endometrial carcinoma, [ 19 ] sigmoid carcinoma, [ 20 ] lung cancer, [ 21 ] and so on.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal metastatic poorly differentiated carcinoma with β-human chorionic gonadotropin secretion presenting as a psoas abscess

Wang

Liu²,

Shao³

et al. 2017

Medicine

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Rationale:Psoas abscesses generally arise from a contiguous intra-abdominal or pelvic infectious process or hematogenous spreading of bacteria. The serum β-human chorionic gonadotropin has been used to detect normal or ectopic pregnancy. It also can be utilized in following up carcinomas.Patient concerns:Here, we reported a case of a 47-year-old woman who presented with a left psoas mass presumptively diagnosed as an abscess secondary to lumbar tuberculosis In addition, the patient had abnormal increase of β-human chorionic gonadotropin. The computed tomography (CT) scan and magnetic resonance imaging (MRI) showed that the 5th lumbar vertebral infection or tuberculosis with left psoas abscess. CT-guided percutaneous biopsy, surgical exploration and biopsy, and 18F-FDG (fluorodeoxyglucose) positron emission tomography-CT (PET-CT) were used to make a definite diagnosis. The sigmoidoscopy and biopsy were used to further diagnose.Diagnoses:The biopsy of left psoas demonstrated metastatic or infiltrating poorly differentiated carcinoma with secretion of β-human chorionic gonadotropin. The subsequent pathological examination of neoplasm showed the same pathologic morphology.Interventions:Appropriate treatment of infected retroperitoneal mass, systematic chemotherapy and cancer biotherapy for metastatic poorly differentiated carcinoma were taken.Outcomes:Interventions provided little help until the patient died of secondary infection and multiple organ failure.Lessons:This case represents an extremely unusual clinical presentation of metastatic poorly differentiated carcinoma with secretion of β-human chorionic gonadotropin presenting as a psoas abscess. Physicians also need to sharpen their awareness of the potential malignant carcinomas mimicking psoas abscess.

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A non-pregnant woman with elevated beta-HCG: A case of para-neoplastic syndrome in ovarian cancer

Cited by 13 publications

References 9 publications

Elevated beta human chorionic gonadotropin in a non-pregnant female diagnosed with anal squamous cell carcinoma

Elevated beta human chorionic gonadotropin in a non-pregnant female diagnosed with anal squamous cell carcinoma

hCG production by mucinous adenocarcinoma of the ovary in a reproductive aged woman

Retroperitoneal metastatic poorly differentiated carcinoma with β-human chorionic gonadotropin secretion presenting as a psoas abscess

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