Osteogenic sarcoma producing human chorionic gonadotrophin: Case report with immunohistochemical studies

Abstract

An osteogenic sarcoma occurring in a 22‐year‐old woman was found to be associated with production of a large amount of beta human chorionic gonadotrophin (B‐hCG). Pregnancy was excluded on the basis of a normal ultrasonogram and a proliferative type endometrium obtained by curettage. A homogenate of the tumor was strongly positive for B‐hCG while immunohistochemical staining of the tumor cells was strongly positive for B‐hCG and negative for pregnancy associated glycoprotein. These results indicate ectopic production of hCG by the osteosarcoma.

A preliminary investigation of Beta-hCG expression in patients with osteosarcoma

“…The apparent association with tumour aggressiveness led some authors to suggest that β-hCG expression may be due to tumour dedifferentiation, but others have found that dedifferentiated cells in their patients did not reveal β-hCG expression. 5,6,10 In the current study, all of our patients with positive β-hCG expression had histologically high-grade tumours of the osteoblastic (three patients) and telangiectatic (two patients) subtypes. In the literature, three cases were of the osteoblastic subtype, two were of the chrondroblastic subtype, and one was of the telangiectatic subtype.…”

“…[1][2][3][4][5][6][7][8][9] The results of our preliminary study suggest that although the incidence of β-hCG expression in osteosarcoma patients may not be high, it raises the question of the possible use of this marker in a subgroup of these patients.…”

“…[1][2][3][4][5][6][7][8][9] Only one report described retrospective immunohistochemical analysis of histological slides, similar to the technique we describe but with a smaller sample size. 7 Our patient whose tissue stained strongly positive for β-hCG expression had a highly aggressive fungating tumour that presented with lung metastases.…”

“…This aggressive presentation correlates with cases reported in the literature whereby two presented with a large mass and skin necrosis over the tumour, two others presented with relapses one to two years following treatment, and another presented with a high grade osteosarcoma. [5][6][7][8] Our preliminary experience suggests that β-hCG expression may be related to tumour aggressiveness, but the incidence of its expression is too low with our small sample size to permit statistical correlation between the characteristics of tumours that do and those that do not express this marker. The apparent association with tumour aggressiveness led some authors to suggest that β-hCG expression may be due to tumour dedifferentiation, but others have found that dedifferentiated cells in their patients did not reveal β-hCG expression.…”

“…4,7 There are only eight patients reported in the literature with a diagnosis of osteosarcoma who were found to have immunohistochemical proof of β-hCG expression. 1,[3][4][5][6][7][8] In six of these there were elevated serum levels of β-hCG. 1,[4][5][6][7][8] Reports suggest the potential use of this glycoprotein as both a prognostic and follow-up marker in patients with osteosarcoma.…”