Metastatic Squamous Cell Carcinoma of the Cervix Secreting Ectopic Serum Beta Human Chorionic Gonadotropin

Abstract

An elevated serum beta human chorionic gonadotropin (beta-hCG) level in a female patient usually demonstrates the presence of a pregnancy or to a lesser extent, gestational trophoblastic disease or ovarian germ cell tumours. We report a case of metastatic cervical squamous cell carcinoma (SCC) presenting with an elevated serum beta-hCG. A 44-year-old Vietnamese lady, para 3, with a past surgical history of a Cesarean section and tubal ligation, was first diagnosed with stage 3B cervical SCC in November 2016 and underwent chemoradiation. She completed her treatment uneventfully and remained disease-free. She then presented to the emergency department in January 2018 complaining of right lower back and abdominal pain for 2 weeks. Her urine pregnancy test was positive and her serum beta-hCG was done which showed an elevated level of 593 IU/mL. Further investigations showed no intra or extra-uterine pregnancy and a magnetic resonance imaging (MRI) of the abdomen and pelvis revealed no pelvic recurrence but presence of a large liver mass and para-aortic lymphadenopathy. Biopsy of the mass confirmed recurrent metastatic cervical SCC. She was not a suitable candidate for surgery and was counseled for palliative chemotherapy. beta-hCG trending revealed a downward trend after commencing on palliative chemotherapy. Ectopic secretion of beta-hCG from tumour cells is a consideration in a patient who has detectable serum beta-hCG but no clinical evidence of pregnancy. Although rare, metastatic or recurrent cervical SCC can secrete serum beta-hCG and case reports have shown presence of serum beta-hCG even in non-gynecological tumours. Larger studies are required to investigate the full potential of serum or urinary beta-hCG in the role of prognosticating SCC of the cervix. J Med Cases. 2018;9(8):252-254 doi: https://doi.org/10.14740/jmc3103w