Pulmonary pleomorphic carcinoma producing hCG

Abstract

An 80-year-old woman with a pleomorphic carcinoma (PC) producing hCG was admitted to Nippon Steel Hirohata Hospital because of an abnormal shadow on CT seen during a follow-up examination after surgery for breast cancer. A right upper lobectomy was performed due to rapid growth of the shadow 3 months later. Macroscopically the tumor was a 4.8 x 4.0 cm well-circumscribed grayish-white mass. On histology the tumor consisted mostly of intermingled spindle and polygonal cells, while evidence of poorly differentiated adenocarcinoma was seen in a few areas. A diagnosis of PC was made due to hCG expression in approximately 20% of the spindle and polygonal cells on immunohistology. Six months after the operation metastasis to the liver and adrenal gland was seen on CT. The patient died due to metastases 1 year after the operation, even though the patient had been at stage 1B at the time of the operation and appropriate chemotherapy had been given. PC patients with immunohistochemical hCG expression have elevated risk of local recurrence and metastasis.

Beta-HCG secretion by a pulmonary pleomorphic carcinoma: A case report

“…Occasionally, PPC may include pleomorphic multi- and/or mononucleated giant cells, resembling syncytiotrophoblastic and cytotrophoblastic cells of choriocarcinoma. Those cells display immunopositivity for HCG, challenging the distinction between primary choriocarcinoma of the lung, and β-HCG expressing pulmonary carcinoma [ 7 ]. Typically, primary choriocarcinoma of the lung (PCL) shows a mixed population of both multinucleated cells (syncytiotrophoblast) and medium-size cells, often with clear cytoplasm (cytotrophoblast) [ 10 ].…”

“…Ectopic secretion of this hormone by other non-trophoblastic malignancies, such as cervical cancer, breast, bladder, ovarian, brain, colorectal, uterine, brain, and lung malignant cell lines, has been described [ 5 ]. However, PPC producing β-HCG is very rare [ [6] , [7] , [8] ].…”

Pleomorphic Carcinoma of the Lung with High Serum Beta-human Chorionic Gonadotropin Level and Gynecomastia

“…In our patient, βhCG levels decreased after surgery, elevated with recurrence, and decreased again with chemotherapy. Hirano et al had suggested that pleomorphic carcinoma patients with immunohistochemical positivity for βhCG have an elevated risk of local recurrence and metastasis [12]. Although our patient initially presented with a stage IB tumor, recurrence occurred in the postoperative 4th month.…”

“…βhCG is usually produced in the human placenta. Although βhCG synthesis in NSCLC is well-known, βhCG producing pleomorphic carcinoma is very rare [8, 12]. Thus, to our knowledge this is the third case of pleomorphic carcinoma of the lung producing βhCG in the literature.…”

Prognostic Significance of β-Human Chorionic Gonadotropin and PAX8 Expression in Anaplastic Thyroid Carcinoma

“…Although b-hCG secretion has been reported in many neoplasms, particularly carcinomas (10)(11)(12)(13)(14)(15)(16), including being detectable in the serum in a minority of them, it has not been described in ATC. In addition, PAX8, an immunohistochemical marker of renal, ovarian, and thyroid carcinomas (17)(18)(19), has been described as a potentially useful (as well as quite sensitive) marker for ATC (19,20).…”