Uterine malignant leiomyosarcoma associated with high levels of serum beta‐human chorionic gonadotropin: A case report

Abstract

We present the case of a 54-year-old woman diagnosed with uterine leiomyosarcoma that produced beta-human chorionic gonadotropin (β-hCG), evident by both serum and immunohistologic examination. Based on this and similar cases from the available literature, β-hCG-producing sarcomas tend to have poorer prognosis, indicating that β-hCG could potentially be used as a marker of disease status and response to the therapy; however, this association is inconsistent and should be further investigated.

β-hCG secreting uterine PEComa

“…There are also conflicting reports with regard to the role of β-hCG as a prognostic biomarker. Previous studies have reported that in some sarcoma cases β-hCG persisted postoperatively 21. In our case, serum β-hCG returned to normal after resection of the primary sarcoma, despite the presence of oligometastatic disease, therefore, this may not be representative of disease activity.…”

“…This is somewhat consistent with our case, as our patient had evidence of oligometastatic spread. However, in our case, β-hCG returned to normal even in the presence of oligometastatic disease, suggesting that it may not be a predictor of the sarcoma’s biological behaviour 21 25. There are also conflicting reports with regard to the role of β-hCG as a prognostic biomarker.…”

“…β-hCG secreting sarcomas are extremely rare and have been described in cases of osteosarcoma, leiomyosarcoma, liposarcoma and phyllodes tumours, and in the majority of these cases β-hCG normalised after treatment of the primary tumour 16–23. Harrold et al described the case of a 35-year-old woman who presented with right knee swelling, and radiological and pathological workup revealed metastatic osteosarcoma 18.…”

“…After undergoing a total mastectomy, β-hCG significantly decreased. With regard to gynaecological sarcomas, three cases of β-hCG producing uterine leiomyosarcomas have been reported in the literature 21–23…”

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

“…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]. To our knowledge, our case is the fourth in literature to describe a case of uterine leiomyosarcoma associated with elevated β-hCG [25][26][27]. What is special about this case was that the initial β-hCG levels were within normal levels, which then showed β-hCG elevation in asso-ciation with the metastatic disease, flare up and resistance to chemotherapy, and palliative radiotherapy, suggesting that β-hCG can potentially play a prognostic role in such patients.…”