1
|
A 3D-printed scaffold-based osteosarcoma model allows to investigate tumor phenotypes and pathogenesis in an in vitro bone-mimicking niche. Mater Today Bio 2022; 15:100295. [PMID: 35665234 PMCID: PMC9161108 DOI: 10.1016/j.mtbio.2022.100295] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
Similar mechanical and structural properties as cortical bones. Recapitulating osteosarcoma phenotypes in morphology, proliferation, cytoskeleton re-organization and energy expenditure. A remarkable potential of ECM remodeling. The transcriptomic analysis to uncover distinct signaling pathways and molecules. Similar expression patterns of biomarkers as clinical trials.
Collapse
|
2
|
Andruska N, Mahapatra L, Brenneman R, MacArthur KM, Oppelt P, Baumann BC. False-positive pregnancy test secondary to ectopic expression of human chorionic gonadotropin by a gastrointestinal stromal tumor. J Surg Oncol 2020; 122:809-812. [PMID: 32615029 DOI: 10.1002/jso.26067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 01/17/2023]
Abstract
Tumors can rarely overexpress human chorionic gonadotropin (hCG) resulting in false-positive pregnancy tests. Here, we report a 44-year-old female with a metastatic gastrointestinal stromal tumor (GIST) who presented with a positive urine pregnancy test before radiotherapy. Further workup ruled out pregnancy. Following radiotherapy, her metastatic disease progressed and her hCG level continued to rise. To the best of our knowledge, this is the first report of a GIST tumor overexpressing hCG.
Collapse
Affiliation(s)
- Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Lily Mahapatra
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Kelly M MacArthur
- Department of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Peter Oppelt
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
3
|
Blank AT, Khalighi M, Randall RL, Jones KB. 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. Rare Tumors 2018; 10:2036361318789727. [PMID: 30093984 PMCID: PMC6081757 DOI: 10.1177/2036361318789727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022] Open
Abstract
Soft tissue sarcomas are a rare group of mesenchymal malignancies which can range from low to high grade. These tumors have different clinical, radiographic, and histopathological characteristics. Beta human chorionic gonadotropin is a naturally secreted hormone by placental syncytiotrophoblast cells during pregnancy. On very rare occasions, sarcomas can develop the ability to ectopically produce human chorionic gonadotropin. Very few cases exist in the literature of soft tissue sarcomas expressing this hormone. We report the case of a 55-year-old female who presented with a posterior thigh soft tissue sarcoma who on the day of surgical resection was found to have an unusually elevated serum human chorionic gonadotropin. Positive immunohistochemical staining of the resected mass confirmed the sarcoma as the source of the beta human chorionic gonadotropin.
Collapse
Affiliation(s)
| | | | - R Lor Randall
- University of California Davis Medical Center, Sacramento California
| | | |
Collapse
|
4
|
Maryamchik E, Lyapichev KA, Halliday B, Rosenberg AE. Dedifferentiated Liposarcoma With Rhabdomyosarcomatous Differentiation Producing HCG: A Case Report of a Diagnostic Pitfall. Int J Surg Pathol 2018. [PMID: 29532681 DOI: 10.1177/1066896918760192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report a first case of paraneoplastic human chorionic gonadotropin (HCG) production in a dedifferentiated liposarcoma with rhabdosarcomatous differentiation in an 83-year-old man with a retroperitoneal mass, unilateral scrotal enlargement, and a serum HCG level of 843 IU/L. Core biopsy of the retroperitoneal mass revealed rhabdomyosarcoma. Orchiectomy revealed a paratesticular dedifferentiated liposarcoma with rhabdosarcomatous differentiation. Fluorescence in situ hybridization analysis performed on both the retroperitoneal and paratesticular masses revealed amplification of MDM2. The retroperitoneal tumor was interpreted as metastatic dedifferentiated liposarcoma with the dedifferentiated component represented by rhabdomyosarcoma. HCG production is a common feature of testicular germ cell tumors, less common in carcinomas, and extremely rare in sarcomas. Accordingly, sarcomas secreting HCG are a potential diagnostic pitfall, and raise the differential diagnosis of germ cell tumors and a variety of carcinomas. HCG production by carcinomas is a known poor prognostic finding, however the significance of its production in sarcomas is unknown.
Collapse
Affiliation(s)
- Elena Maryamchik
- 1 Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kirill A Lyapichev
- 2 University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | | | - Andrew E Rosenberg
- 2 University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| |
Collapse
|
5
|
Abstract
A 35-year-old woman presented to our institution with tender, right knee swelling. Radiological and pathological work-up revealed metastatic osteosarcoma. Prior to the initiation of chemotherapy, she underwent a routine urine pregnancy test and was surprised with a positive result. Serum beta human chorionic gonadotropin (βhCG) levels were also consistently positive and rising. No gestational sac was seen at transvaginal ultrasound. The paraneoplastic ectopic secretion of βhCG has been well described in gestational trophoblastic and gonadal tumours but has very rarely been associated with other tumour types. This patient's βhCG level was reflective of osteosarcoma activity and normalised with response to chemotherapy. The prognostic implications of βhCG expression in more diverse tumours is unclear; however, where raised, it can be used to monitor disease activity.
Collapse
Affiliation(s)
- Emily Harrold
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eileen McMahon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peadar McGing
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | |
Collapse
|
6
|
Mavrogenis AF, Angelini A, Panagopoulos GN, Pala E, Calabrò T, Igoumenou VG, Katzouraki G, Megaloikonomos PD, Pneumaticos SG, Papagelopoulos PJ, Ruggieri P. Aggressive Chordomas: Clinical Outcome of 13 Patients. Orthopedics 2017; 40:e248-e254. [PMID: 27841927 DOI: 10.3928/01477447-20161108-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/26/2016] [Indexed: 02/03/2023]
Abstract
The authors reviewed the files of all patients with chordomas who were admitted and treated at their institutions from 1975 to 2012. Patients were categorized by early local recurrence and metastasis. Aggressive clinical behavior was defined as local recurrence and metastasis within 24 months of diagnosis and adequate treatment (wide en bloc resection with microscopically negative tumor margins). According to these criteria, 13 patients (14.3%) had aggressive chordomas, including 7 men and 6 women, with mean age of 54 years (range, 37-65 years) at diagnosis and treatment. All patients had preoperative tumor biopsy, followed by resection with partial (7 patients) or total sacrectomy (6 patients). In all cases, biopsy and histologic analysis of resected tumor specimens showed conventional chordomas. Resection margins were wide (grossly negative) in 6 patients and wide contaminated in 7 patients. Mean maximum tumor diameter was 11.8 cm (range, 5-21 cm). Mean follow-up was 43 months (range, 8-131 months). Rates of local recurrence, metastasis, and death were evaluated. At the last follow-up, all patients had local recurrence at a mean of 13 months (range, 5-22 months). Histologic examination of recurrent tumors showed a dedifferentiated chordoma with a fibrosarcoma component in 2 patients and no histologic change in the remaining patients. In addition, 8 patients had metastases at a mean of 13 months (range, 4-24 months) and died of their disease. All histologic findings of metastatic lesions were similar to those of primary tumors. Early diagnosis of aggressive tumors requires close follow-up of patients with chordomas. Metastasis is common, with resultant poor survival. [Orthopedics. 2017; 40(2):e248-e254.].
Collapse
|
7
|
Molina P, Torres JV, Navarro S, Llombart-Bosch A. Uterine Carcinoma With Serous and Choriocarcinomatous Differentiation. Int J Surg Pathol 2016. [DOI: 10.1177/106689699600400104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nongestational, nongonadal, and nonteratoma-related choriocarcinoma is an extremely rare entity. The tumor may be pure or associated with carcinoma. Six cases of primary endometrial carcinomas with the presence of syncytiotrophoblastlike beta-human chorionic gonadotropin (beta-HCG)-positive cells have been reported. We describe a case of endometrial carcinoma in a postmenopausal woman, that was composed almost entirely of syncytiotrophoblastic and cytotrophoblastic elements, except in the areas of lymphatic and myometrial invasion, where the neoplasm expressed a papillary serous carcinoma conformation with numerous psammoma bodies. There was not a clear transition between choriocarcinoma and serous carcinoma components. Immunohistochemically, beta-HCG was strongly positive in trophoblastic cells, whereas papillary areas expressed epithelial membrane antigen. These results suggest a double differentiation from malignant stem cells toward an extraembryonal germinal line and a papillary epithelial line. A poor prognosis is expected for this type of neoplasm with extraembryonic differentiation. In the present case, the histologic subtype of uterine papillary serous carcinoma could be an additional risk factor.
Collapse
Affiliation(s)
- P. Molina
- Department of Pathology, Hospital Clinico Universitario, Medical School, Valencia, Spain
| | - J. V. Torres
- Department of Gynecology and Obstetrics, Hospital Clinico Universitario, Medical School, Valencia, Spain
| | | | - A. Llombart-Bosch
- Department of Pathology, Hospital Clinico Universitario, Medical School, Valencia, Spain
| |
Collapse
|
8
|
Beta-human chorionic gonadotropin producing osteosarcoma of the sacrum in a 26-year-old woman: a case report and review of the literature. Case Rep Pathol 2015; 2015:897230. [PMID: 25722909 PMCID: PMC4334429 DOI: 10.1155/2015/897230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/22/2015] [Indexed: 02/04/2023] Open
Abstract
Ectopic secretion of beta-human chorionic gonadotropin is considered a poor prognostic marker in epithelial tumors. However, very few cases have been reported in sarcomas. We present the case of a 26-year-old female who presented with a metastatic osteosarcoma. She underwent usual testing prior to starting treatment and was found to have elevated levels of beta-human chorionic gonadotropin. As the patient was not pregnant, another source of beta-human chorionic gonadotropin secretion had to be considered. The tumor cells demonstrated positive staining for beta-human chorionic gonadotropin by immunohistochemistry, and serum levels of beta-human chorionic gonadotropin were used to monitor tumor progression and response to chemotherapy. We review the literature and discuss a potential role of beta-human chorionic gonadotropin in the treatment of such patients.
Collapse
|
9
|
Lee AF, Pawel BR, Sullivan LM. Significant immunohistochemical expression of human chorionic gonadotropin in high-grade osteosarcoma is rare, but may be associated with clinically elevated serum levels. Pediatr Dev Pathol 2014; 17:278-85. [PMID: 24856811 DOI: 10.2350/14-02-1436-oa.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Survival rates have plateaued at 70% for osteosarcoma. Proteins ectopically produced by malignant tumors may provide insight into new therapeutic targets. Osteosarcomas secreting human chorionic gonadotropin (hCG) have been suggested to have a worse prognosis. We examined the frequency of expression of β-subunit of hCG (β-hCG) in pretreatment osteosarcoma biopsies, and asked if it was associated with various clinical prognostic parameters, and the development of metastases. We subjected 51 pretreatment biopsies of high-grade osteosarcoma, from 51 patients, to β-hCG immunohistochemistry. In 19 of these patients, postchemotherapy metastatic biopsies also were examined for β-hCG expression. Clinical information (patient age, sex, survival status, and serum hCG in females only), and tumor characteristics (site, size, and presence of metastases) were recorded. The β-hCG positive and negative biopsies were separated and compared. Of 49 interpretable pretreatment biopsies, 28 (57%) showed positive cytoplasmic β-hCG expression: 27 with sparse positivity (1% of tumor cells) and 1 with frequent positivity (10% of tumor cells). The patient with frequent β-hCG positivity in her pretreatment biopsy had elevated serum hCG (88.2 mIU/mL) at diagnosis, decreasing to undetectable following chemotherapy and definitive resection. There was no difference in clinical parameters or rate of metastasis between β-hCG positive versus negative groups. Expression of β-hCG may be seen in high-grade osteosarcoma, but frequent β-hCG immunohistochemical expression by tumor cells, associated with clinically elevated serum β-hCG, is rare. Recognition that some nongerm cell tumors may produce β-hCG can prevent confusion with malignancies containing neoplastic syncytiotrophoblast cells, including germ cell and trophoblastic tumors.
Collapse
Affiliation(s)
- Anna F Lee
- 1 Department of Anatomical Pathology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | |
Collapse
|
10
|
Fitzhugh VA, Katava G, Wenokor C, Roche N, Beebe KS. Giant cell tumor of bone with secondary aneurysmal bone cyst-like change producing β-human chorionic gonadotropin. Skeletal Radiol 2014; 43:831-4. [PMID: 24362936 DOI: 10.1007/s00256-013-1785-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/09/2013] [Accepted: 11/12/2013] [Indexed: 02/02/2023]
Abstract
Giant cell tumor of bone is a benign, locally aggressive neoplasm that is composed of sheets of neoplastic mononuclear cells interspersed amongst non-neoplastic, uniformly distributed, osteoclast-like giant cells. They represent approximately 4-5% of primary bone tumors. Rarely, bone tumors have been noted to produce human chorionic gonadotropin, a finding most often reported in osteosarcoma. We present the case of a young woman who presented with a low-level human chorionic gonadotropin level which, after resection of her recurrent giant cell tumor of bone with secondary aneurysmal bone cyst-like change, became undetectable in her blood. Furthermore, cells within the aneurysmal bone cyst component were immunohistochemically positive for β-human chorionic gonadotropin. This is the first report of such a finding in the literature.
Collapse
Affiliation(s)
- Valerie A Fitzhugh
- Department of Pathology and Laboratory Medicine, Rutgers, the State University of New Jersey-New Jersey Medical School, Newark, NJ, 07103, USA,
| | | | | | | | | |
Collapse
|
11
|
Masrouha KZ, Khattab R, Tawil A, Abdallah A, Saghieh S, Haidar R, Abboud M, Khoury NJ. A preliminary investigation of Beta-hCG expression in patients with osteosarcoma. ACTA ACUST UNITED AC 2012; 94:419-24. [DOI: 10.1302/0301-620x.94b3.27679] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There are eight reported cases in the literature of osteosarcomas secreting β-hCG. Our primary aim was to investigate the rate of β-hCG expression in osteosarcoma and attempt to understand the characteristics of osteosarcomas that secrete β-hCG. We reviewed 37 histopathology slides (14 biopsies and 23 surgical specimens) from 32 patients with osteosarcoma. The slides were retrospectively stained for β-hCG expression. Patient and tumour characteristics, including age, gender, tumour location, subtype, proportion of necrosis, presence of metastases and recurrence were recorded. A total of five of the 32 tumours were found to be positive for β-hCG expression (one strongly and four weakly). This incidence of this expression was found in tumours with poor histological response to neoadjuvant chemotherapy. The use of β-hCG expression as a diagnostic, prognostic or follow-up marker is questionable and needs further investigation with a larger sample size.
Collapse
Affiliation(s)
- K. Z. Masrouha
- American University of Beirut Medical
Center, Division of Orthopaedic Surgery, P.O. Box
11-0236, Riad El-Solh, Beirut
1107 2020, Lebanon
| | - R. Khattab
- American University of Beirut Medical
Center, Department of Pathology and Laboratory
Medicine, P.O. Box 11-0236, Riad
El-Solh, Beirut 1107 2020, Lebanon
| | - A. Tawil
- American University of Beirut Medical
Center, Department of Pathology and Laboratory
Medicine, P.O. Box 11-0236, Riad
El-Solh, Beirut 1107 2020, Lebanon
| | - A. Abdallah
- American University of Beirut Medical
Center, Department of Pediatrics and Adolescent
Medicine, P.O. Box 11-0236, Riad
El-Solh, Beirut 1107 2020, Lebanon
| | - S. Saghieh
- American University of Beirut Medical
Center, Division of Orthopaedic Surgery, P.O. Box
11-0236, Riad El-Solh, Beirut
1107 2020, Lebanon
| | - R. Haidar
- American University of Beirut Medical
Center, Division of Orthopaedic Surgery, P.O. Box
11-0236, Riad El-Solh, Beirut
1107 2020, Lebanon
| | - M. Abboud
- American University of Beirut Medical
Center, Department of Pediatrics and Adolescent
Medicine, P.O. Box 11-0236, Riad
El-Solh, Beirut 1107 2020, Lebanon
| | - N. J. Khoury
- American University of Beirut Medical
Center, Department of Diagnostic Radiology, P.O.
Box 11-0236, Riad El-Solh, Beirut
1107 2020, Lebanon
| |
Collapse
|
12
|
Dedifferentiated Liposarcoma of the Retroperitoneum with Extensive Leiomyosarcomatous Differentiation and beta-Human Chorionic Gonadotropin Production. Sarcoma 2011; 2008:658090. [PMID: 18382626 PMCID: PMC2276869 DOI: 10.1155/2008/658090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 11/04/2007] [Accepted: 02/12/2008] [Indexed: 11/29/2022] Open
Abstract
Dedifferentiated liposarcomas may display a variety of “heterologous” lines of differentiation, including osseous, vascular, skeletal, and/or smooth muscular. There have been six previously reported examples of leiomyosarcomas associated with high levels of serum human chorionic gonadotropin (hCG) production, comprised of cases originating from the retroperitoneum, spermatic cord, small intestine, and uterus. This report describes the first example of a dedifferentiated liposarcoma that combined both of the aforementioned features: extensive heterologous (leiomyosarcomatous) differentiation and
β-hCG production (maximum serum levels 1046 mIU/ml, reference <5 mIU/ml). The tumor, which originated in the retroperitoneum in the region of the right kidney, was rapidly progressive and ultimately fatal within three months of its diagnosis. In addition to characteristic morphologic features, lipogenic and smooth muscle differentiation were confirmed with immunohistochemical stains for MDM2 and smooth muscle actin, respectively. The tumor also displayed diffuse immunoreactivity for β-hCG in both primary and metastatic sites. This case further expands the clinicopathologic spectrum of lipogenic tumors.
Collapse
|
13
|
Tuy BE, Obafemi AA, Beebe KS, Patterson FR. Case report: elevated serum beta human chorionic gonadotropin in a woman with osteosarcoma. Clin Orthop Relat Res 2008; 466:997-1001. [PMID: 18288544 PMCID: PMC2504678 DOI: 10.1007/s11999-008-0173-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 01/31/2008] [Indexed: 01/31/2023]
Abstract
Human chorionic gonadotropin is a glycoprotein hormone normally synthesized by placental syncytiotrophoblast cells. It also is secreted by gestational trophoblastic tumors, gonadal tumors, and even various nongonadal tumors, including bone and soft tissue sarcomas, as a paraneoplastic syndrome. The literature contains one case report of beta human chorionic gonadotropin production from a primary bone sarcoma occurring in a male patient. We report a woman of childbearing age who presented with a distal femur lytic lesion, clinical symptoms suggestive of pregnancy, and elevated serum beta human chorionic gonadotropin. Although the clinical diagnosis of a sarcoma was never in doubt, we present this case to emphasize a need to exclude pregnancy in women of childbearing age to avoid delay in biopsy and subsequent management. Positive immunohistochemical staining of the biopsy specimen established the tumor cells as the source of beta human chorionic gonadotropin.
Collapse
Affiliation(s)
- Benjamin E. Tuy
- Division of Musculoskeletal Oncology, Department of Orthopaedics, University of Medicine and Dentistry–New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D1610, Newark, NJ 07103 USA
| | | | - Kathleen S. Beebe
- Division of Musculoskeletal Oncology, Department of Orthopaedics, University of Medicine and Dentistry–New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D1610, Newark, NJ 07103 USA
| | - Francis R. Patterson
- Division of Musculoskeletal Oncology, Department of Orthopaedics, University of Medicine and Dentistry–New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D1610, Newark, NJ 07103 USA
| |
Collapse
|
14
|
Steffensen TS, Gilbert-Barness E, Wagoner MJ, Bui MM, Browarsky IL. Human chorionic gonadotrophin producing epithelioid sarcoma metastatic to the placenta. Fetal Pediatr Pathol 2008; 27:282-91. [PMID: 19065326 DOI: 10.1080/15513810802448225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pregnancy complicated by sarcoma is a rare event, and metastasis to the placenta is exceptionally rare. Of reported malignancies involving the products of conception, only 8% are sarcomas. We report the first case of placental metastasis of an epithelioid sarcoma, an uncommon malignancy which most frequently affects young adults. In addition to the typical histological features and immunophenotypic profile expected of epithelioid sarcoma, this tumor also expressed human chorionic gonadotrophin (HCG). Although uncharacteristic, the production of HCG has been previously reported in other nontrophoblastic tumors. It may have contributed to the pathogenesis of the tumor metastatic to the placenta in this case.
Collapse
Affiliation(s)
- Thora S Steffensen
- Department of Pathology, University of South Florida and Tampa General Hospital, Tampa, Florida 33606, USA
| | | | | | | | | |
Collapse
|
15
|
Demirtas E, Krishnamurthy S, Tulandi T. Elevated serum beta-human chorionic gonadotropin in nonpregnant conditions. Obstet Gynecol Surv 2007; 62:675-9; quiz 691. [PMID: 17868483 DOI: 10.1097/01.ogx.0000281557.04956.61] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Positive serum beta-human chorionic gonadotropin (beta-hCG) in reproductive-age women generally indicates a pregnancy, and to a lesser extent, gestational trophoblastic disease, ovarian or peripheral germ cell tumor. Besides gynecologic conditions, nongynecologic cancers can be associated with beta-hCG positivity as well. The hormone in these tumors varies from detection by the immunohistochemistry studies of the tumor tissue only to a high serum level. This is illustrated by our case report of a 26-year-old woman who was diagnosed with a spindle cell osteosarcoma of the shoulder. The serum beta-hCG became undetectable after chemotherapy. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians Learning OBJECTIVES After completion of this article, the reader should be able to recall that elevated serum hCG can be related to pregnancy, gestational neoplasias, and ovarian and nongynecologic tumors and explain that it is important to appreciate that the hCG detected in these conditions may differ in type and be a marker of the success of treatment.
Collapse
Affiliation(s)
- Ezgi Demirtas
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | | | | |
Collapse
|
16
|
Liang S, Stone G, Chalas E, Pearl M, Callan F, Zheng W. A High-Grade Uterine Leiomyosarcoma With Human Chorionic Gonadotropin Production. Int J Gynecol Pathol 2006; 25:257-61. [PMID: 16810064 DOI: 10.1097/01.pgp.0000192270.22289.af] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ectopic human chorionic gonadotropin production has been described in a wide variety of non-germ cell tumors, particularly in epithelial tumors, but rarely in sarcomas. In this report, we describe the case of 49-year-old woman with a history of "uterine fibroids," who presented with vaginal bleeding and a positive urine pregnancy test. After pregnancy was ruled out by ultrasound, the patient underwent a laparotomy and hysterectomy for a presumptive diagnosis of "fibroids" and was found to have carcinomatosis at the time of the surgery. Therefore optimal debulking of tumors was performed. Two weeks later, the patient developed a small bowel obstruction, which apparently was due to rapid recurrence of tumors in the abdomen, and soon afterwards she died. Microscopically, the resected pelvic mass was composed of highly atypical and pleomorphic spindle cells admixed with many multinucleated giant cells. The tumor had a high mitotic rate along with areas of hemorrhage and necrosis. Immunohistochemically, the tumor cells were positive for vimentin, desmin, smooth muscle actin, and beta-human chorionic gonadotropin, and were negative for epithelial membrane antigen, keratin AE1/3, S-100, CD31, CD117, Ber-EP4, WT-1, estrogen and progesterone receptors. The majority of cells, including the multinucleated giant cells, were strongly immunoreactive for beta-human chorionic gonadotropin. Only three cases of leiomyosarcomas with beta/human chorionic gonadotropin production have been described in the literature, and all three cases had extrauterine origin. Our case, to the authors' best knowledge, is the first uterine leiomyosarcoma with prominent beta/human chorionic gonadotropin production.
Collapse
Affiliation(s)
- Sharon Liang
- Department of Pathology, State University of New York at Stony Brook, Stony Brook, New York 11794, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Froehner M, Theissig F, Konopke R, Detlev Saeger H, Ockert D. Malignant fibrous histiocytoma masquerading as germ cell tumor by producing beta-human chorionic gonadotropin and neuron-specific enolase. Urology 2003; 62:551. [PMID: 12946774 DOI: 10.1016/s0090-4295(03)00379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuron-specific enolase and beta-human chorionic gonadotropin are serum markers frequently found associated with germ cell tumors. To our knowledge, we report the first case of a malignant fibrous histiocytoma producing both markers and discuss the significance of this unusual condition in the differential diagnosis of retroperitoneal tumors.
Collapse
Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | | | | | | | | |
Collapse
|
18
|
Munshi HG, Merajver SD, Valdez R, Baker LH, Cooney KA. Metastatic dedifferentiated chordoma with elevated beta-hCG: a case report. Am J Clin Oncol 2002; 25:274-6. [PMID: 12040287 DOI: 10.1097/00000421-200206000-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chordomas are relatively uncommon bone tumors, and fewer than 10% of cases are classified as dedifferentiated chordomas. These tumors tend to be more clinically aggressive than chordomas and have a higher incidence of early distant metastases. In this case report, we describe a 24-year-old man with dedifferentiated chordoma and multiple pulmonary metastases. Further laboratory analysis revealed an elevated serum beta-human chorionic gonadotropin level. Unfortunately, the patient's clinical condition deteriorated rapidly and he died before receiving any treatment for his cancer. However, chemotherapy may play a useful role in the management of systemic disease in patients with dedifferentiated chordoma.
Collapse
Affiliation(s)
- Hidayatullah G Munshi
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor 48109-0948, USA
| | | | | | | | | |
Collapse
|
19
|
Campbell PA, McKendrick J. Choriocarcinoma of the urinary bladder. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1999; 69:533-7. [PMID: 10442930 DOI: 10.1046/j.1440-1622.1999.01607.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- P A Campbell
- Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia
| | | |
Collapse
|
20
|
Abstract
Trophoblastic differentiation in an extragonadal carcinoma is a rare and unusual phenomenon which has been observed in the carcinomas of stomach, bronchus, esophagus, ovary, liver, urinary bladder, endometrium, and, rarely, in the sarcomas. To our knowledge, this phenomenon has not been observed previously in a mixed mesodermal sarcoma (MMS), and the present communication is to record such a case of MMS of ovary with this phenomenon.
Collapse
Affiliation(s)
- R Barua
- Department of Histopathology, Queen Elizabeth Hospital, Woodville, South Australia
| | | |
Collapse
|
21
|
Burry AF, Munn SR, Arnold EP, McRae CU. Trophoblastic metaplasia in urothelial carcinoma of the bladder. BRITISH JOURNAL OF UROLOGY 1986; 58:143-6. [PMID: 2421816 DOI: 10.1111/j.1464-410x.1986.tb09014.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Trophoblastic differentiation in bladder carcinoma is reported in four patients. Plasma gonadotrophin (beta subunit of HCG), measured in three patients, was elevated. In one patient treated with cisplatin, vinblastine and bleomycin, the beta HCG level fell significantly but progression of malignant disease was not arrested.
Collapse
|