Elevated Serum hCG Research Articles

Amenorrhea and pituitary human chorionic gonadotrophin production in a 38-year-old presenting as pregnancy of unknown location: case report and review of literature

Background: Amenorrhea and extraplacental production of serum human chorionic gonadotropin (hCG), particularly in young women, can mimic a pregnancy of unknown location. Elevated serum hCG in the absence of pregnancy can pose a diagnostic dilemma and has led to potentially harmful and unwarranted interventions including chemotherapeutic agents like methotrexate or have led to delay in necessary medical interventions in women. We report a case to demonstrate that amenorrhea and extraplacental human chorionic gonadotropin (hCG) production in young women can mimic a pregnancy of unknown location. Furthermore, we performed a critical review of literature on pituitary hCG production. Case: A 38-year-old woman with a diagnosis of Silver-Russell syndrome, a unicornuate uterus, history of right oophorectomy for a benign serous cystadenoma and a desire for pregnancy presenting with a provisional diagnosis of pregnancy of unknown location.After performing a thorough review of history, physical examination, ultrasound exams, and a review of hormone analysis [including hCG, Tumor markers, Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Anti-Mullerian Hormone (AMH), Estradiol (E2) levels], we confirmed the diagnosis of premature ovarian insufficiency and pituitary hCG production. Conclusions: In women, serum levels of hCG may increase with age, and are not always an indicator of pregnancy. Therefore, it is imperative to interpret false-positive test results and rule out the extraplacental production of hCG. This will help prevent unnecessary surgical procedures and treatment, including chemotherapy.

Hemodynamical parameters in functional system "motherplacenta-fetus" in women had higher levels of alpha-fetoprotein (AFP) and horionic gonadotropin (HG) in 11 trimester of pregnancy

Haemodinamic parameters in the functional system mother-placenta-fetus in 49 women with elevated mildtrimester maternal serum AFP (2MoM) and in 38 women with elevated maternal serum hCG (2MoM) were studed. The control group included 32 women with normal mildtnmester serum AFP and hCG. Indexes of impedance to flow in the uterine arteries were significantly higher in patients with elevated MSAFP or MShCG comparing with women of the control group, beginning from 28 weeks of pregnancy. There was a significant association between the maternal serum AFP levels and indexes of impedance to flow in the uterine artery, umbilical artery and fetal aorta during pregnancy. In patients with abnormal (more then 95th centile) uterine arteries Resistance Index at 2024 weeks, abnormal dynamic of MSAFP and MShCC levels from 16 until 24 weeks was observed. We suppose that unexplained elevated mildtri mester maternal serum AFP and hCC сaп be associated with disturbed utero-placental circulation.

The Value of Hysteroscopy in Women with Persistently Elevated Post-Evacuation Serum Human Chorionic Gonadotropin (hCG) Level Following Evacuation of Molar Disease

Abstract Background and rational Gestational trophoblastic disease (GTD) is a spectrum of trophoblastic diseases that encompass the hydatidiform mole (both complete and partial), as well as the potentially-malignant and malignant forms: invasive mole, choriocarcinoma and placental site trophoblastic tumor. Gestational trophoblastic neoplasia (GTN) refers to persistent elevation of serum levels of human chorionic gonadotropin (hCG). The subsequentmanagement of GTD after evacuation of the uterus relies on serial surveillance of serum hCG levels. When serum hCG levels plateau or rise, chemotherapy should promptly be initiated. Patients and Methods This study for accuracy of a diagnostic test. The current study was conducted at Gynecologic Oncology Unit and Early Cancer Detection Unit at Ain Shams University Maternity Hospital during the period between January 2016 and June 2018. Results In the present study, the case who had a vascular mass, the patient was 44 years old and she was para 4, so board decision was for TAH. Postoperative serum hCG surveillance for this case showed adequately declining levels. She, accordingly, did not receive chemotherapy. For the 19/44 (43.2%) cases who had a hysteroscopic finding of ‘an empty cavity’ were diagnosed as persistent GTN and received chemotherapy according to the protocol. The remaining 25/44 (56.8%) cases, who had a hysteroscopic finding of ‘remnants’, underwent re-evacuation. Postoperative serum hCG surveillance showed persistently elevated levels in 9/44 (20.5%) cases, who, therefore, received chemotherapy according to the protocol; and adequately declining levels in 16/44 (36.4%) cases, who, accordingly, did not receive chemotherapy. Conclusion The hysteroscopy significantly reduced the risk of chemotherapy in women with hydatidiform mole and have persistent post-evacuation elevated serum hCG level and sonographic criteria of invasive disease.

Complete molar pregnancy in adolescents from North and South America: Clinical presentation and risk of gestational trophoblastic neoplasia

ObjectivesTo compare complete hydatidiform mole (CHM) clinical presentation and risk factors associated with GTN development between North American and South American adolescents. MethodsThis non-concurrent cohort study was undertaken including adolescents with CHM referred to centers in North America (New England Trophoblastic Disease Center, Harvard University, USA), and South America (Botucatu Trophoblastic Disease Center-São Paulo State University, Brazil; Trophoblastic Unit of Central University of Venezuela and Maternidad Concepcion Palacios of Caracas, Venezuela) between 1990 and 2012. Data were obtained from medical records and pathology reports. Study participants were allocated into 2 groups: North America (NA) and South America (SA). ResultsIn NA and SA, 13.1% and 30.9% of patients with hydatidiform mole were adolescents, respectively. Of these, 77.6% in NA and 86.1% in SA had pathologic diagnosis of CHM (p=0.121). Vaginal bleeding (SA=69% vs NA=51%; p=0.020), anemia (SA=48% vs NA=18%; p<0.001), and elevated serum hCG (SA=232,860mIU/mL vs NA=136,412mIU/mL; p=0.039) were more frequent in SA than in NA. Median gestational age at diagnosis (SA=12weeks, NA=11weeks; p=0.030) differed whereas GTN development rate (SA=20%, NA=27%; p=0.282) showed no significant difference between groups. Compared to NA, medical complications and clinical factors associated with post-molar GTN were more frequent among SA adolescents. ConclusionsMedical complications and clinical factors associated with GTN development were more frequent in SA than in NA adolescents with CHM, suggesting that, in South America, awareness about the importance of diagnosing molar pregnancy early and considering CHM in the differential diagnosis in adolescents suspected to be pregnant should be raised.

Outcomes of children with central nervous system germinoma treated with multi-agent chemotherapy followed by reduced radiation.

CNS germinomas have an excellent prognosis with radiation therapy alone. However, in children, volume and dose of CNS radiation are associated with neurocognitive and neuroendocrine sequelae. Our objective was to determine long-term outcomes of our cohort who received chemotherapy and reduced radiation. This retrospective cohort study analyzed treatment and outcome of intracranial germinoma patients consecutively treated at Sick Kids, Toronto, Canada, from January 2000 to December 2013. 24 children (13 male, 11 female; median age 13.36years) were identified. Median follow up was 61months (range 1-144months). Tumor location was suprasellar (n=9), bifocal (8), pineal (6), and basal ganglia (1). Three children showed dissemination on imaging. 2/24 had only elevated serum human chorionic gonadotropin, 3/24 only elevated lumbar cerebrospinal fluid (CSF) hCG, and 2/24 had both elevated serum and lumbar CSF hCG. 23/24 children completed treatment and received multi-agent chemotherapy followed by either ventricular radiation (2340-2400cGy) (n=9), ventricular radiation+boost (1600cGy) (n=8), whole brain (2340cGy) (n=3), focal (4000cGy) (n=2) or craniospinal radiation (2340cGy) (n=1). Five-year progression free and overall survival was 96 and 100% respectively. 8/24 patients with ventricular radiation±boost (2340/4000cGy) displayed stable full scale intelligence quotient over a mean interval of 3years following radiation, but showed declined processing speed. In this limited experience, excellent 5-year overall survival rates were achieved with chemotherapy followed by reduced whole ventricular radiation even if ventricular radiation was delivered without boost.

Mid-trimester maternal serum AFP and hCG as markers of preterm and term adverse pregnancy outcomes.

To evaluate the predictive values of mid-trimester serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) for preterm and term placenta-mediated adverse pregnancy outcomes (PMAPOs). We extracted data for nulliparous women with a singleton pregnancy without aneuploidy or lethal fetal anomalies from a prospective cohort study. Maternal serum AFP and hCG measured between 13 and 17 weeks of gestation and expressed as multiples of the median (MoM) for gestational age were compared between women who developed a PMAPO (preeclampsia, intrauterine growth restriction, fetal death) before term or at term and women who did not develop any of these complications. Among 3466 nulliparous women, maternal serum AFP and hCG levels were available in 2110 and 2125 cases, respectively. Women who developed a PMAPO before term had a higher median level of serum AFP (1.4 vs. 1.1 MoM; P < 0.01) and hCG (1.3 vs. 1.1 MoM; P < 0.01) than controls. A serum hCG > 2.0 MoM was associated with a higher risk of PMAPO before term (RR 4.6; CI 95% 2.3 to 9.1) but had no impact on the risk of PMAPO at term (RR 1.1; CI 95% 0.7 to 1.7). Maternal serum AFP > 2.0 MoM was also associated with a significant increase in the risk of preterm PMAPO (RR 3.9; CI 95% 1.6 to 9.8) but not term PMAPO (RR 1.2; CI 95% 0.6 to 2.3). Maternal serum AFP or hCG > 2.0 MoM increases the risk of preterm PMAPO but not term PMAPO in our population. We suggest that women with elevated serum AFP or hCG should receive standard pregnancy care once they have reached 37 weeks of gestation if fetal growth is in the normal range.

OP24.07: Systemic methotrexate as an effective treatment for non‐viable caesarean section scar pregnancy

There is no consensus on the management of caesarean scar ectopic pregnancy (CSP). We aim to identify factors affecting treatment outcome using systemic methotrexate. Cases of CSP were reviewed retrospectively in a teaching hospital from January 2011 to December 2013. The diagnosis was based on the following sonographic criteria: an empty uterus, an empty cervical canal and presence of the sac in the anterior part of the uterine isthmus. Cases were classified into 2 groups; Group A - successful treatment by systemic methotrexate (im MTX) 50 mg/m3 alone with complete resolution of serum hCG; Group B - failure of im MTX as evident by persistently elevated serum hCG requiring additional treatment. In addition, a search of English-language literature was performed in PubMed using keyword ‘caesarean scar pregnancy’, from year 2009 to 2013. Cases with systemic MTX alone as initial treatment were included in the analysis. The association of maternal age, number of C/S, time from last C/S, pre-treatment serum hCG level, fetal cardiac activity, maximum sac diameter, time for serum hCG resolution in both groups were analyzed using Mann-Whitney U test and Barnard's Exact test as appropriate. Fourteen cases of CSP were diagnosed during the studied period with 12 cases used systemic MTX alone as initial treatment. About 300 cases were identified in PubMed and 7 cases satisfied the inclusion criteria. Total 19 cases were included for analysis, 14 cases (74%) with successful treatment with systemic MTX were in group A and 5 cases (26%) were in group B. All cases in group A had single dose systemic MTX as the treatment regime. Analysis showed that fetal cardiac activity was associated with failed treatment by systemic MTX (p = 0.04). All other factors were not useful in predicting the treatment outcome (p > 0.05). Systemic methotrexate is an effective treatment for non-viable caesarean scar ectopic pregnancy.

Significant immunohistochemical expression of human chorionic gonadotropin in high-grade osteosarcoma is rare, but may be associated with clinically elevated serum levels.

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.

PMM.88 Screening for Down’s Syndrome in Women with Renal Disease

IntroductionIn 2001, the UK National Screening Committee advised that all pregnant mothers should be offered a screening test for Down’s syndrome (DS). This is performed at first (biomarkers and ultrasound)...

HCG in screening for aneuploidy: A possible role for its glycoforms?

Fetal trisomy 21 is associated with elevated maternal serum hCG and its free beta-subunit (hCG-beta) in vivo, and abnormal placental hCG production and glycosylation in vitro. Other maternal serum markers may also be disrupted in major aneuploidies (T21, T18, T13). We evaluated our aneuploidy screening practices, focusing on hCG-beta and hCG glycoforms, and retrospectively analyzed 55 aneuploidy cases diagnosed over a 2 year period, determining maternal serum hCG glycoforms profiles using 2D-electrophoresis. Screening efficiency reached 96.7%. T21 was associated with elevated hCG-beta while T18 presented with diminished serum markers. hCG glycoforms tended to be basic in aneuploidy (mainly T13).

Ultrasound of ovarian dermoids - sonographic findings of a dermoid cyst in a 41-year-old woman with an elevated serum hCG.

Ovarian dermoid cysts are made up of solid, cystic and fat tissue. These components give rise to characteristic sonographic features such as a fat‐fluid level, dermoid mesh and tip of the iceberg sign. The presence of two or more of these typical features can be used to confidently diagnose a dermoid cyst on ultrasound. This 41‐year‐old woman with a known cystic lesion on her right ovary which, on ultrasound, demonstrated two of these features, had the diagnosis of a dermoid cyst later confirmed on histopathology. She concurrently had an elevated serum human chorionic gonadotrophin (hCG), an unusual, but not unknown, finding in the presence of a dermoid cyst. The hCG resolved after removal of the ovarian cyst.

Villous trophoblast abnormalities in extremely preterm deliveries with elevated second trimester maternal serum hCG or inhibin-A

Elevated levels of the maternal prenatal screening markers hCG and inhibin-A, measured at 15–20 weeks gestation, increase the subsequent risk of severe pre-eclampsia and intra-uterine growth restriction (IUGR). Since both markers are produced by syncytiotrophoblast, we tested the hypothesis that these elevations were due to accelerated differentiation of the villous trophoblast compartment. We performed a retrospective study of 12 cases from our Placenta Clinic with total hCG and/or inhibin-A levels of ≥3.0 multiples of the median that subsequently delivered by 28 weeks gestation and compared their placental pathology findings with 24 gestational age-matched controls. Morphometric analysis demonstrated a 41% reduction in the volume ratio of Ki67 positive cytotrophoblast nuclei to total trophoblast in cases vs controls (Student’s T-test; p = 0.028). Distal villous hypoplasia (DVH) was significantly more common in cases (10/12) than controls (4/24); Fisher’s exact test, p = 0.002. Wave-like syncytial knot (WLSK) formation was significantly more common in cases (9/12) than controls (1/24); Fisher’s exact test, p < 0.0001. WLSK formation was associated with DVH and resulted from accumulation of senescent/apoptotic syncytiotrophoblast nuclei along inherent lines of syncytial nuclear organization. Our data support the hypothesis that elevated second trimester maternal serum levels of total hCG and/or inhibin-A may result from premature accelerated differentiation of the villous cytotrophoblasts. The subsequent pathologic findings in the syncytiotrophoblast could render the pregnancy at risk of severe pre-eclampsia and IUGR.

False elevation of human chorionic gonadotropin in a patient with testicular cancer

A 44-year-old, HIV-positive man presented with a painless swelling of his left testicle. He underwent left radical orchiectomy for a pathological stage T1 nonseminomatous germ cell tumor (NSGCT). A persistently elevated postoperative human chorionic gonadotropin (hCG) level resulted in the patient being diagnosed as having low-risk, stage 1S disseminated NSGCT. He was treated with four cycles of etoposide and cisplatin chemotherapy, but his hCG level had not returned to normal at the end of the treatment. Postchemotherapy CT showed no evidence of metastatic disease. Measurement of serum levels of tumor markers, including alpha-fetoprotein, hCG and lactate dehydrogenase, scrotal ultrasonography, HIV-1 reverse transcriptase polymerase chain reaction, CT of the thorax, abdomen and pelvis, assessment of kidney function, and measurement of follicle-stimulating hormone and luteinizing hormone levels. Falsely elevated serum hCG level caused by heterophile antibody interference in the hCG immunoassay. The patient's postchemotherapy serum samples were reanalyzed using a heterophile antibody blocking agent, the results of which showed no detectable hCG. No salvage therapy was required, and the patient remains in complete remission.

Assessing the role of placental trisomy in preeclampsia and intrauterine growth restriction

Prenatally diagnosed confined placental trisomy is associated with increased risk for intrauterine growth restriction (IUGR) and preeclampsia. However, it is unclear how often this might underlie pregnancy complications. Our objective was to evaluate the frequency and distribution of trisomic cells in placentae ascertained for IUGR and/or preeclampsia. Comparative genomic hybridization was applied to two uncultured biopsies from each of 61 placentae referred with maternal preeclampsia and/or IUGR, 11 cases with elevated maternal serum hCG and/or AFP but no IUGR or preeclampsia, and 85 control placentae. Trisomy was observed in four placentae among the IUGR group (N = 43) but in no case of preeclampsia in the absence of IUGR (N = 18). Trisomy was observed in 1 of the 11 cases ascertained for abnormal maternal serum screen. Each of these five cases was mosaic and not all sampled sites showed the presence of trisomy. None of the 84 control placentas showed mosaic trisomy, although 1 case of nonmosaic 47,XXX was identified in this group. In cases in which diagnosis of the cause of IUGR may provide some benefit, testing should be performed using uncultured cells from multiple placental biopsies for the accurate diagnosis of trisomy mosaicism.

Conservative management of placenta increta after first trimester abortion by transcatheter arterial chemoembolization: a case report and review of the literature

Placenta increta is a potentially life-threatening condition that may complicate a first trimester abortion in rare occasion. However, the therapeutic value of transcatheter arterial chemoembolization for the conservative management of this disorder is not described. A 27-year-old woman (gravida 3, para 1) with significant obstetric history for one previous lower segment cesarean section and one dilatation and curettage for missed abortion had uncomplicated dilatation and curettage for missed abortion. Eight weeks after curettage, the patient presented with increased amounts of vaginal bleeding. Image diagnostic modalities localized the heterogeneous mass within the myometrium in the fundal portion of the uterine corpus. Initially, arteriovenous fistula formation after abortion was suspected. However, an elevated serum hCG value indicated the presence of retained placental tissue and gave the diagnosis of persistent placenta increta after a first trimester abortion. Transcatheter arterial chemoembolization with dactinomycin was initiated to achieve immediate hemostasis and cytocidal effects on the placental tissue. The post-interventional course was uneventful. Twenty days after chemoembolization, the serum hCG value decreased to a normal level and the mass lesion disappeared on ultrasonography without secondary hemorrhagic complications. After precise diagnostic imaging, transcatheter arterial chemoembolization is a useful minimally invasive procedure to achieve uterine preservation in women with placenta increta masquerading as arteriovenous fistula after a first trimester abortion.

Fine needle aspiration diagnosis of bilateral dysgerminoma with syncytiotrophoblastic giant cells

Dysgerminoma accounts for only 1–3% of ovarian cancers and about 30–40% of all ovarian germ cell malignant tumors. Literature states that about 2% of nonpregnant patients with dysgerminomas present with elevated serum or urine levels of human chorionic gonadotropin (hCG). Here, we report a 34 year-old multiparous woman presenting with an abdominal lump, ascites, and abdominal pain with elevated urinary and serum hCG levels. An abdominal ultrasound showed bilateral ovarian mass. An ultrasound-guided, transabdominal fine needle aspiration revealed dysgerminoma with syncytiotrophoblastic giant cells. Bilateral oophorectomy was done and the diagnosis was confirmed on histopathology.

False-Positive Serum Human Chorionic Gonadotropin (hCG) in a Male Patient with a Malignant Germ Cell Tumor of the Testis: A Case Report and Review of the Literature

A 39-year-old male patient with a favorable prognosis stage IIB metastatic malignant germ cell tumor (GCT) and elevated pre- and postorchiectomy serum human chorionic gonadotropin (hCG) was treated with three courses of combination chemotherapy resulting in a rapid normalization of his serum hCG. Within 2 months after the cessation of chemotherapy, his serum hCG increased again, suggesting tumor recurrence. Pathological examination of the resected residual retroperitoneal lymph nodes revealed no vital tumor cells. Based on the further rise in his serum hCG and enlargement of mediastinal lymph nodes on computed tomography scan, the patient underwent second- and third-line chemotherapy, which did not result in normalization of his serum hCG. Reanalysis of stored serum samples with other immunoassays revealed that the elevated serum hCG levels collected before first-line chemotherapy were indeed elevated, but those collected after first-line chemotherapy were all falsely positive. Currently, the patient is still alive and disease free. This is the first report of a male cancer patient who received unneeded second- and third-line chemotherapy for relapse based on false-positive hCG results. We discuss the pitfalls of false-positive serum hCG measurements, including heterophilic antibodies, as in our IgA-deficient patient, and review the literature.

Ultrasound Detection of Placental Insufficiency in Women With Elevated Second Trimester Serum Alpha-Fetoprotein or Human Chorionic Gonadotropin

ObjectiveWe evaluated the role of placental morphology ultrasound and uterine artery Doppler in predicting adverse perinatal outcomes in women with unexplained elevated serum alpha-fetoprotein (AFP) or human chorionic gonadotropin (hCG) levels in the second trimester of pregnancy. MethodsWomen with a serum AFP > 2.0 MoM (n = 83) or serum hCG > 2.5 MoM (n = 68) had placental imaging at 19–23 weeks’ gestation. Abnormal placental morphology (i.e., a maximum thickness of > 4 cm or > 50%of length) and abnormal uterine artery Doppler [UTAD] (mean pulsatility index > 1.45) were related to placental complications of pregnancy. Relative risks were derived for all women. Likelihood ratios were derived for the subset (55/83) in the group with elevated AFP who had no medical and/or obstetrical risk factors. ResultsCompared with elevated serum hCG, an elevated serum AFP was associated with higher rates of perinatal mortality (15.6% vs. 4.3%), preterm birth at < 32 weeks’ gestation (26.5% vs. 7.3%), small-for-gestational age (SGA) birth weight < 10th centile (24.1% vs. 10.3%) and severe intrauterine growth restriction (IUGR) (8.4% vs. 2.8%). Thirty-seven (44.5%) women with elevated serum AFP had an adverse perinatal outcome, and 23 of these women (67%) had no prior medical and/or obstetric risk factors. Abnormal tests of placental function were more common in the elevated serum AFP group than in the hCG group (UTAD 30.1% vs. 11.6%; placental morphology 30.2% vs. 16.2%). Abnormal UTAD and abnormal placental morphology had similar positive likelihood ratios for a range of adverse perinatal events in the elevated AFP group (1.3–4.4) and were increased when both tests were abnormal (likelihood ratio 5.0 for preeclampsia, 4.5 for preterm delivery < 32 weeks, 4.9 for intrauterine fetal demise). In the elevated hCG group abnormal UTAD and abnormal placental morphology predicted SGA (likelihood ratios 5.2 and 4.9) and IUGR (likelihood ratios 4.7 and 7.3) but did not predict preeclampsia or preterm birth. ConclusionAssessment of placental function using either morphology or UTAD at 19–23 weeks’ gestation identifies a subset of women at increased risk of adverse perinatal events with an elevated serum AFP. These tests have more limited value in women with an elevated serum hCG because of the lower prevalence of adverse perinatal events.

Endometrioid carcinoma of the endometrium with choriocarcinomatous differentiation: a case report and review of the literature

An endometrioid adenocarcinoma (EAC) with true trophoblastic differentiation is a rare event with a highly aggressive clinical course. We report an endometrioid adenocarcinoma of the endometrium in which there was a morphologically conventional-appearing EAC component admixed with multinucleated giant cells and large pleomorphic tumor cells that resembled a choriocarcinoma without an elevated serum level of human chorionic gonadotropin (hCG) in a 42-year-old unmarried woman with a history of abnormal uterine bleeding. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection were performed. Histopathologic study of the specimen showed endometrioid adenocarcinoma extended to the deep myometrium with a focus of hemorrhagic and necrotic tumor composed of multinucleated giant cells, large pleomorphic tumor cells, suggesting choriocarcinomatous differentiation (CD). Immunohistochemical studies demonstrated intense reactivity of tumor cells for human chorionic gonadotropin (hCG) confirming the diagnosis. A complete clinical workup ruled out metastatic spread to the brain, lungs, skeleton, or abdomen. The patient was alive with no evidence of disease 6 months later. Although endometrioid adenocarcinoma with choriocarcinomatous differentiation is known to behave in a more aggressive course, this disease may have a good prognosis with a clinically indolent course when it is small, and without elevated serum hCG levels.

Elevated Serum β-Human Chorionic Gonadotropin in Nonpregnant Conditions

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. Obstetricians & Gynecologists, Family Physicians Learning 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.