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Alzibdeh A, Mohamad I, Al-Hussaini M, Salah S, Jaradat A, Abuhijlih R, Abuhijla F. Significance of Beta Human Chorionic Gonadotropin in Predicting Disease Progression in Uterine Leiomyosarcoma. World J Oncol 2024; 15:143-148. [PMID: 38274716 PMCID: PMC10807911 DOI: 10.14740/wjon1748] [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: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 01/27/2024] Open
Abstract
Uterine leiomyosarcoma is a high-grade sarcoma that might be associated with dismal outcome. There are no hematological markers that can be used to follow up the recurrence and/or progression of the tumor. We present a case of a 44-year-old female, who was diagnosed with uterine leiomyosarcoma. During her management course, serum beta human chorionic gonadotropin (β-hCG) elevation was correlated with clinical and radiological disease progression on two separate occasions. This correlation should be further investigated to potentially integrate serum β-hCG as a predictive tool for clinical behavior and treatment response.
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Affiliation(s)
- Abdulla Alzibdeh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | | | - Samer Salah
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | | | - Ramiz Abuhijlih
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Fawzi Abuhijla
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
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2
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Vari S, Riva F, Onesti CE, Cosimati A, Renna D, Biagini R, Baldi J, Zoccali C, Anelli V, Annovazzi A, Covello R, Ascione A, Casini B, Ferraresi V. Malignant Transformation of Giant Cell Tumour of Bone: A Review of Literature and the Experience of a Referral Centre. Int J Mol Sci 2022; 23:ijms231810721. [PMID: 36142631 PMCID: PMC9506170 DOI: 10.3390/ijms231810721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022] Open
Abstract
Giant cell tumour of bone (GCTB) is a benign, locally aggressive primary bone neoplasm that represents 5% of all bone tumours. The principal treatment approach is surgery. Although generally GCTB is considered only a locally aggressive disease, it can metastasise, and lung metastases occur in 1–9% of patients. To date, only the use of denosumab has been approved as medical treatment for GCTB. Even more rarely, GCTB undergoes sarcomatous transformation into a malignant tumour (4% of all GCTB), but history of this malignant transformation is unclear and unpredictable. Considering the rarity of the event, the data in the literature are few. In this review, we summarise published data of GCTB malignant transformation and we analyse three cases of malignant transformation of GCTB, evaluating histopathology, genetics, and radiological aspects. Despite the rarity of this event, we conclude that a strict follow up is recommended to detect early malignant transformation.
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Affiliation(s)
- Sabrina Vari
- UOSD Sarcomas and Rare Tumors, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Federica Riva
- UOSD Sarcomas and Rare Tumors, IRCCS Regina Elena National Cancer Institute, Sapienza University of Rome, 00144 Rome, Italy
| | - Concetta Elisa Onesti
- UOSD Sarcomas and Rare Tumors, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
- Correspondence:
| | - Antonella Cosimati
- UOSD Sarcomas and Rare Tumors, IRCCS Regina Elena National Cancer Institute, Sapienza University of Rome, 00144 Rome, Italy
| | - Davide Renna
- UOSD Sarcomas and Rare Tumors, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Roberto Biagini
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Jacopo Baldi
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Carmine Zoccali
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Vincenzo Anelli
- Radiology Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Alessio Annovazzi
- Nuclear Medicine Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Renato Covello
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Andrea Ascione
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Beatrice Casini
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Virginia Ferraresi
- UOSD Sarcomas and Rare Tumors, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
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3
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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.
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4
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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.
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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
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5
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Boss DS, Glen H, Beijnen JH, de Jong D, Wanders J, Evans TRJ, Schellens JHM. Serum β-HCG and CA-125 as Tumor Markers in a Patient with Osteosarcoma: Case Report. TUMORI JOURNAL 2018; 97:109-14. [DOI: 10.1177/030089161109700119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Elevated β-HCG serum levels are usually an indication of pregnancy or pregnancy-related disorders, but β-HCG can also be elevated in testis and germ cell tumors. HCG expression by osteosarcoma is a rare phenomenon, with a few documented cases. CA-125 is commonly used to monitor disease progression and treatment response in ovarian cancer. CA-125 expression in patients with osteosarcoma has not previously been documented. Case report Elevated β-HCG and CA-125 serum levels were observed in a female patient of 57 years of age with metastatic osteosarcoma during screening investigations prior to participation in a phase I clinical trial. Pregnancy was excluded. Immunohistochemical studies revealed the tumor to be the source of the elevated β-HCG serum levels. We found no CA-125 expression in tumor tissue. The patient was treated with E7080, a novel oral multi-targeted tyrosine kinase inhibitor. We measured serum β-HCG and CA-125 to monitor treatment response. She had a significant clinical and radiological response after two cycles of treatment, but developed progressive disease after the third cycle. The β-HCG serum levels seemed to better reflect her disease status than those of the other tumor marker, CA-125. Conclusions When elevated, β-HCG serum levels in patients with osteosarcoma might be used to monitor treatment. Treatment of advanced osteosarcoma with tyrosine kinase inhibitors, including E7080, warrants further investigation. Free full text available at www.tumorionline.it
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Affiliation(s)
- David S Boss
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hilary Glen
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, Slotervaart Hospital, Amsterdam, The Netherlands
- Science Faculty, Department of Pharmaceutical Sciences, Division of Biomedical Analysis, Utrecht University, Utrecht, The Netherlands
| | - Daphne de Jong
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - TR Jeffry Evans
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jan HM Schellens
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Science Faculty, Department of Pharmaceutical Sciences, Division of Biomedical Analysis, Utrecht University, Utrecht, The Netherlands
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6
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Morris CD, Hameed MR, Agaram NP, Hwang S. Elevated β-hCG associated with aggressive Osteoblastoma. Skeletal Radiol 2017; 46:1187-1192. [PMID: 28396962 DOI: 10.1007/s00256-017-2647-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/21/2017] [Accepted: 03/28/2017] [Indexed: 02/02/2023]
Abstract
We present a unique case of an aggressive scapular osteoblastoma that produced β-hCG as a paraneoplastic manifestation in a 20-year-old woman. Serum β-hCG was found to be elevated during presurgical workup and consequently delayed surgical resection of the increasingly painful tumor because of suspected pregnancy. The paraneoplastic production of β-hCG was later proven by positive immunohistochemical stain of β-hCG in a curettage specimen and normalization of β-hCG levels after surgical resection of the aggressive osteoblastoma. Production of beta-human chorionic gonadotropin (β-hCG) has been reported in several carcinomas and sarcomas but, to our knowledge, it has not been reported in osteoblastoma in the English-language literature.
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Affiliation(s)
- Carol D Morris
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - Meera R Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Narasimhan P Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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7
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Abstract
Multifocal osteosarcoma is usually defined as the occurrence of a tumor at 2 or more sites in a patient without pulmonary metastases and may be synchronous with more than one lesion seen at presentation or metachronous with new tumors developing after the initial treatment. It is difficult to determine whether these represent synchronous multiple primary lesions or metastases. We present a rare case of widespread synchronous multifocal osteosarcoma and a brief review of the literature.
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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.
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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
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9
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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.
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10
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Discrepant serum and urine β-hCG results due to production of β-hCG by a cribriform-morular variant of thyroid papillary carcinoma. Clin Chim Acta 2014; 438:181-5. [PMID: 25181612 DOI: 10.1016/j.cca.2014.08.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although patients with medullary thyroid cancer are known to present with paraneoplastic hormone production, this is much less common with papillary thyroid cancer. METHODS We present a patient with the cribriform morular variant of papillary thyroid cancer in association with familial adenomatous polyposis who developed a positive pregnancy test in the absence of known pregnancy. The patient had developed vaginal bleeding, and her laboratory testing was characterized by elevated serum human chorionic gonadotropin (β-hCG) concentrations, but negative qualitative urine results. After a thorough gynecological evaluation to exclude unexpected normal, ectopic, or molar pregnancy, we pursued an evaluation for other sources of β-hCG production. RESULTS We showed that the elevated serum β-hCG concentrations were not the result of heterophile antibody interferences, and ultimately we proved that her recurrent tumor produced the ectopic β-hCG. This is the first report of β-hCG production by papillary thyroid cancer. Thus, the possibility of ectopic production of β-hCG by papillary thyroid cancer needs to be included in the differential diagnosis of elevated hCG concentration in the absence of pregnancy. CONCLUSIONS This study of an unusual paraneoplastic syndrome highlights the importance of investigating discrepancies in the clinical laboratory.
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11
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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.
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Affiliation(s)
- Anna F Lee
- 1 Department of Anatomical Pathology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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12
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Immunohistochemistry in Dermatopathology: A Review of the Most Commonly Used Antibodies (Part I). ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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Inmunohistoquímica en dermatopatología: revisión de los anticuerpos utilizados con mayor frecuencia (parte i). ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:99-127. [DOI: 10.1016/j.ad.2012.02.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 02/02/2012] [Indexed: 11/30/2022] Open
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Ectopic production of human chorionic gonadotropin by synovial sarcoma of the hip. Obstet Gynecol 2013; 121:468-71. [PMID: 23344411 DOI: 10.1097/aog.0b013e31826d3121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human chorionic gonadotropin (hCG) is a marker of pregnancy and a tumor marker for some gynecologic malignancies, including germ cell tumors and gestational trophoblastic neoplasia. Rarely, hCG is secreted by nongynecologic tumors, confounding the diagnosis. CASE A 45-year-old woman was evaluated for a persistently elevated β-hCG. Diagnosis of her primary malignancy, synovial sarcoma of the hip, was delayed as more common etiologies were considered, including ectopic pregnancy and gestational trophoblastic neoplasm. The workup eventually led to the diagnosis using imaging studies but ultimately resulted in a 3-month delay and unnecessary medical and surgical treatments. CONCLUSION This case highlights the importance of nongynecologic malignancies when evaluating patients with a persistent β-hCG.
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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.
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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
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16
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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.
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Reisenbichler ES, Krontiras H, Hameed O. Βeta-Human Chorionic Gonadotropin Production Associated with Phyllodes Tumor of the Breast: An Unusual Paraneoplastic Phenomenon. Breast J 2009; 15:527-30. [DOI: 10.1111/j.1524-4741.2009.00772.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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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.
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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
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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.
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Affiliation(s)
- Ezgi Demirtas
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Abstract
AbstractCarcinosarcomas are rare tumours, which have both epithelial, and connective tissue elements. They are most commonly seen in the female genital tract. Rarely they arise from the gastrointestinal tract. We report a case of Carcinosarcoma arising as a primary in the spleen of a male aged 60yrs. The most unique feature of this tumour is the presence of osteosarcomatous element. This report highlights the importance of clinical awareness of such rare tumours and gives a brief overview on presentation, probable aetiology, diagnosis and management with literature review of carcinosarcoma.
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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.
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Affiliation(s)
- Sharon Liang
- Department of Pathology, State University of New York at Stony Brook, Stony Brook, New York 11794, USA.
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