Ectopic Production of β-hCG by Osteosarcoma

Abstract

Ectopic production of β-human chorionic gonadotropin (β-hCG) by nontrophoblastic tumors has been reported but mostly in carcinomas. We report a case of an adolescent female patient with a epithelioid osteosarcoma that was discovered to secrete β-hCG after routine pregnancy testing. Immunohistochemical staining of her primary tumor biopsy demonstrated immunoreactivity for β-hCG. Levels of serum β-hCG were monitored throughout her therapy and demonstrated normalization with effective systemic therapy and local control. She remains disease free 6 months off therapy, with undetectable hormone levels. A review of the available literature on β-hCG production by sarcomas is also presented.

Beta-Human Chorionic Gonadotropin Producing Osteosarcoma of the Sacrum in a 26-Year-Old Woman: A Case Report and Review of the Literature

“…Leidinger et al reported positive staining in dedifferentiated metastases of negatively staining primary tumors [ 6 ], and Masrouha et al reported that four of the five cases stained positively in histologically high-grade tumors [ 5 ]. However, Oshrine et al reported no morphological differences between β -hCG-positive and β -hCG-negative cells within the same tumor [ 7 ]. In our case, the tumor appeared of low-grade and, similar to Orhrine's findings, no noticeable differences were seen between β -hCG-positive and β -hCG-negative areas.…”

Don’t cancel the surgery just yet! A case report of positive preoperative pregnancy test due to a soft tissue sarcoma production of ectopic beta human chorionic gonadotropin

“…Workup and treatment of the femoral lesion revealed a high-grade osteosarcoma which stained positive for β-hCG. Oshrine et al 8 in 2014 also reported a case of osteosarcoma in an adolescent female which was secreting β-hCG. Serum β-hCG levels became undetectable by the end of her sarcoma treatment.…”

Significance of Beta Human Chorionic Gonadotropin in Predicting Disease Progression in Uterine Leiomyosarcoma

“…In the available literature, there are a few documented cases of β-hCG-producing sarcomas. β-hCG production was described in a small number of primary and recurrent osteosarcomas and osteogenic sarcomas [11][12][13][14][15], phyllodes tumors [16], dedifferentiated liposarcomas [17,18] and synovial sarcomas [19]. In extra-uterine cases, elevated β-hCG was described in retroperitoneal leiomyosarcoma [18,20,21], spermatic cord leiomyosarcoma [22,23], and leiomyosarcoma of the small bowel [24].…”