Βeta-Human Chorionic Gonadotropin Production Associated with Phyllodes Tumor of the Breast: An Unusual Paraneoplastic Phenomenon

Abstract

Phyllodes tumors (PTs) of the breast are uncommon and account for < 1% of all breast tumors. Most patients present with mass lesions; however, there are rare reports of patients presenting with paraneoplastic conditions such as hypoglycemia secondary to insulin-like growth factor II secretion. A 55-year-old woman presented with a rapidly enlarging left breast mass which ulcerated through the skin and invaded the underlying muscle. The serum beta-human chorionic gonadotropin (beta-hCG) level was found to be 58 mIU/mL preoperatively; this dropped to 2 mIU/mL after surgery. Mastectomy showed a 14.5-cm fibroepithelial neoplasm, the majority of which was composed of a cellular spindle/epithelioid-cell proliferation with the focal presence of elongated epithelial clefts consistent with a PT. In addition to the presence of unequivocal sarcomatous stromal overgrowth and prominent mitotic activity, there were areas of lace-like osteoid production by tumor cells, and a diagnosis of malignant PT with osteosarcomatous foci was rendered. Immunohistochemical studies showed focal beta-hCG expression within the epithelioid stroma of the tumor; expression of p63 and cytokeratin was only seen in the epithelial component and there was no expression of placental alkaline phosphatase in either component. Although beta-hCG expression/production has been described in many nontrophoblastic tumors (mostly carcinomas of various organs), to our knowledge this is the first case documenting this in a PT of the breast. Whether this intriguing finding represents an isolated association or has more significant implications remains to be determined.

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

“…[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.…”

“…1 In addition, β-hCG may be produced by nongynaecological organs, including the testes, and breast. 9 Therefore, increased blood levels might be found in patients with tumours arising from these organs, particularly of the testes, bladder, and pancreas. 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.…”

Familial HCG syndrome: A diagnostic challenge

“…Although uncommon, malignancies other than germ cell tumours can also present with elevated hCG levels such as with upper gastrointestinal, lung and breast cancer. ( Kenny and McAleer, 2004 , Szturmowicz et al, 1995 , Reisenbichler et al, 2009 ).…”

BetaHCG secretion by a pulmonary adenocarcinoma

“…Paraneoplastic BetaHCG secretion has been reported in cases of squamous cell carcinoma of the head and neck [8], phyllode tumors of the breast [9], clear cell renal cell carcinoma [10], and leiomysarcoma [11]. …”