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Mosaffa SL, Eapen G, Kalhor N, Sneige N. Non-small cell lung carcinoma with ectopic gonadotropin production: A case report and review of the literature. Diagn Cytopathol 2024; 52:397-399. [PMID: 38576061 DOI: 10.1002/dc.25318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Sara L Mosaffa
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Georgie Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neda Kalhor
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nour Sneige
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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2
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Shibata N, Nyuzuki H, Sasaki S, Ogawa Y, Okada M, Nagasaki K. Peripheral precocious puberty in a girl with an intracranial hCG-producing tumor: case report and literature review. Endocr J 2021; 68:1463-1467. [PMID: 34275973 DOI: 10.1507/endocrj.ej21-0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Human chorionic gonadotropin (hCG)-producing tumors cause peripheral precocious puberty (PP) in boys, but generally not in girls. Homology between LH and hCG activates the LH receptor in testicular Leydig cells, increases testosterone production, and causes virilization. However, since FSH action is required for follicle development, hCG action alone does not increase estradiol (E2) production and does not cause feminization. Only a few cases of peripheral PP with hCG tumors in girls have been reported. We describe the case of a 7-year-old Japanese girl with peripheral PP associated with an hCG-producing tumor. She had prolonged vomiting, loss of appetite, and Tanner stage III breast development. Although no apparent increase in growth rate, bone age was advanced at 9.8 years. Serum E2 was slightly elevated and LH and FSH were below the measurement sensitivity, and abdominal ultrasonography and computed tomography images showed no abnormal findings in the uterus or ovaries. Subsequently, she developed visual field disturbance and loss of consciousness, and brain magnetic resonance imaging revealed an intracranial tumor. Based on pathological findings and abnormally high serum hCG-β level (48,800 IU/L), intracranial choriocarcinoma was diagnosed. 2.5 months after the start of chemotherapy, the hCG-β level became almost negative and the breast development disappeared synchronously. Tissue immunostaining of the tumor showed strong positivity for aromatase and hCG, indicating that the choriocarcinoma cells themselves may have produced estrogen via aromatase. This unique case highlights the possibility that hCG-producing tumors can cause peripheral PP in girls as well as boys.
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Affiliation(s)
- Nao Shibata
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Hiromi Nyuzuki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Sunao Sasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Yohei Ogawa
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
- Division of Community Medicine, Department of Community Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Masayasu Okada
- Department of Neurosurgery, Brain Research Institute, School of Medicine and Graduate School of Medical/Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
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He Y, Bhoopathy V, Habashy D, Adams S, McCombie SP, Arianayagam M. Spontaneous bleeding from an unusual renal mass: A case of gestational choriocarcinoma related to previous pregnancy over a decade earlier. Urol Case Rep 2021; 37:101614. [PMID: 33842209 PMCID: PMC8020421 DOI: 10.1016/j.eucr.2021.101614] [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: 01/22/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 10/27/2022] Open
Abstract
Gestational choriocarcinoma is an uncommon trophoblastic malignancy, occurring in females after pregnancy, which is rarely encountered by urologists. It can be rapidly progressive, however metastases to other organs can occur after a prolonged latency period. We describe a rare case of solitary metastatic gestational choriocarcinoma presenting with spontaneous bleeding from a renal mass, over a decade after the associated pregnancy with a presumed sub-clinical primary tumour. This case demonstrates the importance of recognising gestational choriocarcinoma as a potential differential diagnosis of spontaneous bleeding renal mass in females of child-bearing age as a urologist given the often-aggressive nature of the disease.
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Affiliation(s)
- Yilu He
- Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, Australia
| | - Varun Bhoopathy
- Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, Australia
| | - David Habashy
- Nepean Urology Research Group, Nepean Hospital, PO Box 63, Penrith, NSW, 2751, Australia
| | - Stuart Adams
- NSW Health Pathology, Nepean Hospital, Penrith, NSW, 2751, Australia
| | - Steve P McCombie
- Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, Australia.,Fiona Stanley Hospital, Murdoch, WA, Australia.,University of Western Australia, Crawley, WA, Australia
| | - Mohan Arianayagam
- Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, Australia
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Lazopoulos A, Krimiotis D, Schizas NC, Rallis T, Gogakos AS, Chatzinikolaou F, Tsiouda T, Zarogoulidis P, Sarafis P, Kamparoudi P, Paliouras D, Barbetakis N. Galactorrhea, mastodynia and gynecomastia as the first manifestation of lung adenocarcinoma. A case report. Respir Med Case Rep 2019; 26:146-149. [PMID: 30603606 PMCID: PMC6307343 DOI: 10.1016/j.rmcr.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/30/2018] [Accepted: 12/02/2018] [Indexed: 12/24/2022] Open
Abstract
Gynecomastia with mastodynia and galactorrhea as a paraneoplastic syndrome due to lung cancer with complete response after surgical excision is rare. A 62-year-old Caucasian male presented with mastodynia, galactorrhea and right breast enlargement. Chest x-ray revealed a left upper lobe tumor. The patient had high levels of serum beta-human chorionic gonadotropin (b-HCG) and prolactine. Complete staging was negative for metastases. A typical left upper lobectomy with radical mediastinal lymph node dissection was performed. Pathology report was consistent with a poorly differentiated adenocarcinoma (T2N1M0). Immunohistochemically, multinucleate cells and occasional mononucleate tumor cells showed positivity for human chorionic gonadotropin. The patient received adjuvant chemotherapy with cisplatin - navelbine. One year later physical examination showed regression of both gynecomastia and mastodynia and there was no nipple discharge, while he is free from local or distant metastatic disease and the b-HCG level is normal (1,59 mIU/ml). This case represents a very rare, first manifestation of lung cancer. Galactorrhea, mastodynia and gynecomastia were the initial symptoms, which totally resolved following the successful surgical resection and adjuvant chemotherapy. In this case, prolactin and b-HCG are useful biomarkers during follow up for checking local or distal recurrence of the disease.
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Affiliation(s)
- A Lazopoulos
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - D Krimiotis
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - N C Schizas
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - T Rallis
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - A S Gogakos
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - F Chatzinikolaou
- Department of Forensic Medicine, Aristotle University of Thessaloniki, Greece
| | - T Tsiouda
- Pulmonary Department - Oncology Unit, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - P Zarogoulidis
- Pulmonary Department, "St. Luke" Private Hospital, Panorama, Thessaloniki, Greece
| | - P Sarafis
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - P Kamparoudi
- Anesthesiology Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - D Paliouras
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - N Barbetakis
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
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Hegemann M, Kroeger N, Stenzl A, Bedke J. Rare and changeable as a chameleon: paraneoplastic syndromes in renal cell carcinoma. World J Urol 2018; 36:849-854. [PMID: 29429069 DOI: 10.1007/s00345-018-2215-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/31/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Paraneoplastic syndromes (PNS) in renal cell carcinoma (RCC) are important to be recognized by the treating physician, because they may lead to diagnosis of underlying malignant disease. On the other hand, PNS may dominate the clinical picture and can hide the true disorder like a chameleon. When realized, a PNS can be used as a 'neoplastic tumour marker', especially in case of recurrence. Their occurrence can even be linked to prognosis of disease. METHODS A PubMed search combining the MeSH terms renal cell carcinoma and paraneoplastic syndrome was executed in April 2015. All hits concerning these MeSH terms have been taken into account when writing this review. RESULTS There is a big gap between reporting and incidence of paraneoplastic syndromes in renal cell carcinoma. Most of the articles in Medline are case reports and reviews of research done in the 1950s-1990s. One problem is that a clear definition of a paraneoplastic syndrome is still lacking. The most important PNS in RCC are hypercalcemia. It is important that PNS are not only arising in advanced stages of renal cell carcinoma; in contrast, a PNS can often be the first symptom of RCC. CONCLUSION Paraneoplastic syndromes are often unrecognized but are important biomarkers in RCC. Further research into the underlying pathomechanisms of PNS may improve our understanding of the RCC tumour biology and is urgently needed.
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Affiliation(s)
- M Hegemann
- Department of Urology, Eberhard Karls University Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - N Kroeger
- Department of Urology, Ernst-Moritz-Arndt University Greifswald, Ferdinand Sauerbruch Str, 17475, Greifswald, Germany
| | - A Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - J Bedke
- Department of Urology, Eberhard Karls University Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
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6
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Groza D, Duerr D, Schmid M, Boesch B. When cancer patients suddenly have a positive pregnancy test. BMJ Case Rep 2017; 2017:bcr-2017-220493. [PMID: 28668822 DOI: 10.1136/bcr-2017-220493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We present the case of non-small cell lung cancer (NSCLC) in a 48-year-old woman with an active history of smoking. The patient initially presented to her general practitioner with a progressive swelling on the neck. Further investigations diagnosed a metastatic lung tumour, and palliative chemotherapy was started. After 5 months of treatment, by newly reported amenorrhoea, cautiously before a restaging CT scan of the abdomen, a pregnancy test was performed and was positive. Both the gynaecological examination and the hormonal panel yielded no signs of pregnancy. Immunohistochemically, staining of the tumour was strongly positive for β-subunit of human chorionic gonadotropin (β-hCG) suggesting that the tumour was responsible for high β-hCG levels.Paraneoplastic β-hCG secretion from adenocarcinomas is rare. In the literature, only a few such cases have been reported. Previous studies suggested that the ability to secrete β-hCG in tumours may correlate to some extent to chemoresistance and thus, to a worse prognosis.
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Affiliation(s)
- Daniela Groza
- Internal Medicine, Stadtspital Triemli, Zurich, Switzerland.,Oncology, Stadtsspital Triemli, Zürich, Switzerland
| | - Donat Duerr
- Department of Oncology, Stadtspital Triemli, Zurich, Switzerland
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Ferraz de Campos FP, Narvaez MRA, Reis PVS, Gomes ACM, Paraskevopoulos DKDS, Santana F, Fugita OEH. Acanthosis Nigricans associated with clear-cell renal cell carcinoma. AUTOPSY AND CASE REPORTS 2016; 6:33-40. [PMID: 27284539 PMCID: PMC4880432 DOI: 10.4322/acr.2016.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/31/2016] [Indexed: 12/29/2022] Open
Abstract
Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia. The latter, also known as malignant AN, is mostly related to abdominal neoplasms. Malignant AN occurs frequently among elderly patients. In these cases, the onset is subtle, and spreading involves the flexural regions of the body, particularly the axillae, palms, soles, and mucosa. Gastric adenocarcinoma is the most frequent associated neoplasia, but many others have been reported. Renal cell carcinoma (RCC), although already reported, is rarely associated with malignant AN. The authors report the case of a woman who was being treated for depression but presented a long-standing and marked weight loss, followed by darkening of the neck and the axillary regions. Physical examination disclosed a tumoral mass in the left flank and symmetrical, pigmented, velvety, verrucous plaques on both axillae, which is classical for AN. The diagnostic work-up disclosed a huge renal mass, which was resected and further diagnosed as a RCC. The post-operative period was uneventful and the skin alteration was evanescent at the first follow-up consultation. The authors call attention to the association of AN with RCC.
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Affiliation(s)
| | | | | | | | | | - Frederico Santana
- Pathology Department - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
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Tran M, Daly P, Tran T, Heathcote P. Renal cell carcinoma metastases to the spermatic cord: review of the literature and case presentation. JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/2051415813488360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a case of clear cell renal cell carcinoma with metachronous metastasis to the ipsilateral spermatic cord. We also review the literature of the rare instance of renal cell carcinoma metastasising to the spermatic cord.
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Affiliation(s)
- M Tran
- Department of Urology, Princess Alexandra Hospital, Australia
| | - P Daly
- Department of Urology, Princess Alexandra Hospital, Australia
| | - T Tran
- Department of Urology, Princess Alexandra Hospital, Australia
| | - P Heathcote
- Department of Urology, Princess Alexandra Hospital, Australia
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9
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Vicier C, Tabouret E, Tallet A, Gonçalves A, Chetaille B, Viens P, Madroszyk A. BetaHCG secretion by a pulmonary adenocarcinoma. World J Surg Oncol 2013; 11:228. [PMID: 24034807 PMCID: PMC3847484 DOI: 10.1186/1477-7819-11-228] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/11/2013] [Indexed: 12/20/2022] Open
Abstract
We report a rare case of metastatic non-small-cell lung cancer in a 43-year-old woman with a history of smoking. The tumor secreted human chorionic gonadotropin and its beta subunit (BetaHCG). The patient presented with amenorrhea, a positive pregnancy test and chest pain. A physical examination and investigations revealed no pregnancy, and it was determined that a paraneoplastic syndrome stemming from a pulmonary tumor was responsible for the secretion of BetaHCG. This secretion decreased with tumor response to chemotherapy. Only a few reports of paraneoplastic BetaHCG secretion can be found in the literature for several different cancers.
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Affiliation(s)
- Cécile Vicier
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France.
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Okutur K, Hasbal B, Aydin K, Bozkurt M, Namal E, Oz B, Kaynak K, Demir G. Pleomorphic carcinoma of the lung with high serum beta-human chorionic gonadotropin level and gynecomastia. J Korean Med Sci 2010; 25:1805-8. [PMID: 21165299 PMCID: PMC2995238 DOI: 10.3346/jkms.2010.25.12.1805] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 06/25/2010] [Indexed: 01/15/2023] Open
Abstract
Although gynecomastia is a well-defined paraneoplastic syndrome in patients with non-small cell lung cancer, the association with pleomorphic carcinoma has not been reported. A 50-yr-old man presented with bilateral gynecomastia and elevated serum beta-human chorionic gonadotropin (βhCG) level. Chest tomography showed a mass in the right middle lobe. Right middle lobectomy and mediastinal lymph node dissection were performed. βhCG levels decreased rapidly after surgery. Histological examination revealed pleomorphic carcinoma with positive immunostaining for βhCG. Serum βhCG levels began to increase gradually on postoperatively 4th month. Computed tomography detected recurrence and chemotherapy was started. After second cycle of chemotherapy, βhCG levels decreased dramatically again and tomography showed regression in mass. Patient died 6 months later due to brain metastasis. βhCG expression may be associated with aggressive clinical course and increased risk of recurrence, also βhCG levels may be used to evaluate therapy response in patients with pleomorphic carcinoma.
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Affiliation(s)
- Kerem Okutur
- Department of Medical Oncology, Istanbul Bilim University School of Medicine, Istanbul, Turkey.
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Renin expression in adult renal epithelial tumors with granular cells. Pathol Res Pract 2010; 206:731-4. [DOI: 10.1016/j.prp.2010.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 06/04/2010] [Accepted: 06/04/2010] [Indexed: 10/19/2022]
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