Elevated β-hCG Levels Research Articles

Case Report: Spontaneous cornual Pregnancy at 7 Weeks: A Gynecological challenge

Introduction and Importance Cornual pregnancy (CP) is a rare and dangerous type of ectopic pregnancy, occurring in 2% to 4% of cases. Due to its atypical location in the uterine horn, it poses a high risk for severe complications, such as rupture of the uterus, and life-threatening bleeding, particularly when diagnosis is delayed. Case Presentation We report the case of a 35-year-old female patient presenting with severe pelvic pain and vaginal bleeding, with 12 weeks of amenorrhea. Clinical evaluation revealed elevated β-HCG levels and transvaginal ultrasound showed a 7-week unruptured right cornual pregnancy. Surgical management involved a mini-laparotomy, which confirmed the diagnosis and a cornuostomy along with a right salpingectomy was performed. The patient’s postoperative course was uneventful, and follow-up confirmed complete recovery. Clinical Discussion Cornual pregnancies, though rare, carry a significant risk of serious complications and maternal death due to delayed diagnosis. Risk factors encompass a history of miscarriage, elective abortion, sexually transmitted infections, and smoking, all contributing to abnormal implantation. Early diagnosis is challenging but crucial, with ultrasound being key for detection. Management depends on gestational age, patient stability, and future reproductive plans, with methotrexate or surgical intervention being standard options. Conclusion Cornual pregnancy, despite its rarity, demands prompt and accurate diagnosis to prevent catastrophic outcomes. This case underscores the need for individualized treatment strategies and highlights the importance of early intervention. Ongoing research is vital to improving diagnostic approaches and therapeutic outcomes.

Elevated β-HCG levels after spontaneous abortion in a 33-year-old woman

Elevated β-HCG levels after spontaneous abortion in a 33-year-old woman

Investigating the function of serum B-HCG levels in the prognosis of hypertensive pregnancy disorders: A prospective observational study

Pregnancy-related hypertensive diseases are a serious hazard to world health. Identifying predictive markers is crucial for timely intervention. Serum β-HCG, known for its diverse role in pregnancy, is explored due to its potential involvement in vascular remodeling and angiogenesis. The prospective observational study involves 200 pregnant women, monitored from early gestation to delivery. Serum β-HCG levels are evaluated at different time points. Data collection includes clinical assessments, obstetric evaluations, and blood sample analysis. Statistical analysis is conducted using MedCalc software. Among 200 cases, elevated serum β-HCG levels (≥2 MoM) show a higher prevalence of hypertensive disorders (HDOP) compared to lower levels (<2 MoM). Maternal and fetal outcomes are explored, revealing adverse outcomes associated with elevated β-HCG levels. Age, religion, and parity distributions are analyzed for their correlation with HDOP. The study establishes a strong correlation between the onset of HDOP and increased β-HCG levels. There is no discernible relationship between age and HDOP, while religious variations and parity suggest potential relationships. The study also highlights a significant link between proteinuria and HDOP. For a thorough understanding, more studies with bigger sample numbers and controlled designs are advised.

To Study Serum β-HCG in Early Second Trimester as Predictors of Pregnancy Induced Hypertension

Background: Hypertensive disorders of pregnancy are a mysterious and clinically complex category of pregnancy problems that account for a significant burden of disease in both industrialized and less industrialized nations. The aim of this study is to estimate Serum β-HCG levels in early second trimester as predictors of pregnancy-induced hypertension. Methodology: A cross-sectional study was conducted among pregnant females in their second trimester attending the OPD clinic in the Department of Obstetrics & Gynaecology, JK Hospital, LNMC & RC, Bhopal, from January 2019 to June 2020. A total of 150 pregnant women were included in the study based on inclusion and exclusion criteria. Data was collected and entered into an Excel sheet and analyzed using EpiInfo software with appropriate statistical methods. Result: The study observed that the majority of pregnant women (52%) were in the 26-30 years age group. The highest number of women were at 17-18 weeks of gestation, and most of them were primigravida (39.3%). The mean β-HCG level of mothers in the pregnancy induced hypertension (PIH) group was 54297.8±22302.7, while that of mothers in the normal group was 27018.2±11255.7. The difference between the means was statistically very highly significant (P<0.001). The sensitivity and specificity of elevated β-HCG levels as a predictor of PIH were 67.2% and 75%, respectively, with a positive predictive value of 62.9% and a negative predictive value of 78.4%. Conclusion: Pregnancy-induced hypertension remains a little understood entity, despite the enormous impact of its complications on maternal and fetal outcomes. The study concludes that the frequency of pregnancy-induced hypertension at a tertiary care hospital is 38.6%. Elevated serum β-HCG levels in women with second trimester pregnancy indicate an increased risk of gestational hypertension and preeclampsia, and higher β-HCG levels are associated with the severity of the disease. Women with raised β-HCG levels should be arefully followed up for hypertension, and appropriate referrals to a tertiary care center for better treatment should be made.

Non-choriocarcinomatous trophoblastic tumors of testis in postchemotherapy retroperitoneal lymph node dissections.

Non-choriocarcinomatous trophoblastic tumors (NCTTs) are seldomly diagnosed in male genital tract. As they have been recently described among the testicular germ cell tumor (TGCT) variants, pathologists' familiarity with their morphology is limited. We searched our electronic hospital records covering the years 2000-2017 for post-chemotherapy retroperitoneal TGCT metastectomies. Slides of all cases with viable tumor were retrieved from the archives and reviewed. Cases suspected of N-CTT morphologies were subjected to immunohistochemistry. Twelve NCTTs were identified, 9 of which were unseen or misdiagnosed by the original pathologists: Cystic trophoblastic tumor (CTT) (n = 5), placental site trophoblastic tumor (n = 2), epithelioid trophoblastic tumor (ETT) (n = 4), and coinciding PSTT + ETT (n = 1). Eight of these were associated with mature teratoma components, and one case (ETT) contained embryonal carcinoma and yolk sac tumor in addition to teratoma. Ten patients were clinically N1 at the time of primary tumor detection and orchiectomy. One patient had burned-out primary testicular tumor. Six patients were clinical M1a at presentation, while one male was cM1b. Six patients had mildly elevated β-HCG (≤ 410 mIU/ml) just prior to retroperitoneal lymph node dissections (RPLND), while the others had normal β-HCG levels. All patients had follow-ups ranging from 8 to 118months (mean 42.3months). Three patients died of disease-related and two of unrelated causes. In conclusion, because NCTTs are rare and newly described tumor types, their diagnosis is difficult and most of them are missed in post-chemotherapy RPLNDs. The majority of patients exhibit normal or slightly elevated β-HCG levels. N-CTTs are usually accompanied by other components of TGCT, the most common being teratoma. Despite the high survival rate of the patients, our study points to the unpredictable evolution of NCTT cases, which may concur with a high-stage or progressive disease.

Extrauterine Epithelioid Trophoblastic Tumor (ETT) Arising from an Antecedent Undiagnosed Molar Pregnancy Presenting as an Adnexal mass: A Case Report

Abstract Introduction/Objective Epithelioid trophoblastic tumor (ETT) is an extremely rare neoplasm derived from chorionic type intermediate trophoblast. ETT usually follows an antecedent term pregnancy but can also follow spontaneous abortions or molar pregnancy. ETT most often arises from the endometrium, followed by the cervix. Extrauterine ETT are extremely rare, with few cases reported in literature. Methods/Case Report A 41-year-old woman with three term pregnancies presented with abdominal pain, ten years after her last pregnancy. Imaging findings of a 3.5 cm adnexal mass coupled with an elevated serum β-hCG (~ 900 mIU/ml), led to the suspicion of an ectopic pregnancy. Hysterectomy with salpingectomy revealed a 4.7 cm, tan- yellow, necrotic mass in the adnexal region abutting but distinct from the uterine serosa. Histologic evaluation showed a well- circumscribed tumor with pushing borders. The tumor cells were epithelioid with well-defined eosinophilic cytoplasm, monomorphic nuclei, frequent mitosis, and abundant geographic necrosis. The tumor cells were positive for β-hCG, GATA-3, PLAP and inhibin, with focal weak staining squamous markers p63 and p40. DNA fingerprinting analysis, performed to confirm the diagnosis of ETT, revealed a homozygous tumor with two copies of non-maternal genes indicating that the antecedent index gestation giving rise to the tumor was an undiagnosed hydatidiform mole. Following surgery, serum β-hCG levels were normal and the patient is currently on surveillance. Results (if a Case Study enter NA) NA Conclusion We present an extremely rare case of extrauterine ETT arising from a previously undetected molar pregnancy. The diagnosis should be suspected when a mass is observed at extrauterine sites with elevated β-hCG levels in patients with or without vaginal bleeding. Histologic differential of squamous cell carcinoma needs to be ruled out with immunostains. Due to its rarity and highly variable presentation, this entity remains a diagnostic challenge. DNA fingerprinting analysis demonstrating non-maternal genes can help confirm the diagnosis of ETT.

A Case of HCG-Mediated Hyperthyroidism Related to Metastatic Choriocarcinoma

Introduction: We present a clinical case of a non-seminomatous germ cell choriocarcinoma producing human chorionic gonadotrophin (HCG) and inducing hyperthyroidism. Clinical Case: A 21-year-old male with recently diagnosed metastatic non-seminomatous germ cell choriocarcinoma presented with persistent tachycardia and anxiety. At diagnosis, his β- human chorionic gonadotrophin (β-HCG) was elevated to 6,435 mIU/mL (normal <1 in male) and thyroid-stimulating hormone (TSH) was within normal limits. At presentation, however, his β-HCG increased to 103,229 mIU/mL, TSH was suppressed <0.02 mcIU/mL (normal 0.3-4.7), and free thyroxine was elevated (FT4) 2.6 ng/dL (normal 0.8-1.7). His thyrotoxicosis improved with initiation of methimazole; however, his TSH remained undetectable due to persistently elevated β-HCG levels. His course was complicated by hemorrhagic shock and acute liver injury in the setting of a presumed intraluminal gastric metastasis, necessitating the discontinuation of methimazole. He was continued on steroids to try to minimize T4 to T3 conversion, but ultimately his thyroid hormones uptrended. He became stable enough to tolerate 5 days of chemotherapy, after which his FT4 quickly normalized. Unfortunately, he continued to suffer from vasodilatory shock and ultimately passed away. Discussion: It has been demonstrated that HCG can bind to the TSH receptor and has thyrotropic activity. The development of hyperthyroidism requires HCG levels >200,000 mIU/mL that are sustained for several weeks (1). It is unknown what the prevalence of hyperthyroidism is in choriocarcinoma, but it has been shown to greatly increase when serum HCG levels are greater than >50,000 mIU/mL (2). Conclusion: Hyperthyroidism can be difficult to recognize in patients suffering from cancer as many of the typical symptoms can also be seen with active malignancy. Patients with HCG-secreting tumors should be evaluated for hyperthyroidism and may benefit from treatment until the underlying cause can be managed.

SUN-009 Variable Presentation of Two Patients with Gestational Trophoblastic Disease and Hyperthyroidism

Background: Gestational trophoblastic disease (GTD) represents a group of tumours caused by abnormal proliferation of trophoblastic cells, including molar pregnancy. Elevated β-hCG levels are an established marker for the presence of the disease and useful for monitoring. Due to the shared structural homology of β-hCG and TSH, hyperthyroidism can occur. Clinical Cases: We present two patients with GTD associated with hyperthyroidisim. Case 1, a 20 year old female (G1P0) presented to the emergency department complaining of vaginal bleeding associated with abdominal pain. She was estimated to be 13 weeks. Laboratory evaluation were β-hCG 648 324 IU/L, TSH 0.06 (0.35 - 4.94 mIU/L, free T4 23.2 (9.0 - 19.0 pmol/L, Hb 8.0 (11.6 - 16.4 g/dL). Ultrasound revealed molar pregnancy. She underwent uterine evacuation, thereafter complicated with thyroid storm (Burch Wartofsky score = 45). Post- operative vitals were BP 192/112, pulse rate 120 bpm and temperature 360C. She was managed in high care on labetolol, carbimazole, lugol’s iodine and hydrocortisone.She was subsequently referred to Medical Oncology for further management. Histology sample obtained in theatre confirmed complete molar pregnancy.Her staging CT scan indicated the presence of small lung nodules, suggesting metastatic disease. The patient’s FIGO/WHO score was III: 2. At the time of preparing this study, she had already received 7 weeks of methotrexate intramuscularly and still had detectable β-hCG levels.Case 2 was a 31 year old female presented similarly. This was her second pregnancy (G2P1), 12 weeks by dates. Her vitals were BP 141/74, pulse rate 110 bpm and temperature 36oC. The Ultrasound revealed larger for gestational age uterus with cystic structures in utero. Her quantitative β-hCG was significantly elevated (> 1 500 000 IU/L) she was thyrotoxic [TSH (<0.1 (0.34 - 4.94 mIU/L) free T4 (47.2 (9.0 - 19.0 pmol/L)], however did not develop thyroid storm (Burch Wartofsky score = 20). This patient also underwent uterine evacuation and did well post operatively. She was treated for her thyrotoxicosis with carbimazole, propranolol and thiamine. Further management was by Medical Oncology. Histological examination was in keeping with a partial mole.Her staging CT scan showed no metastasis, and had a FIGO/WHO score of 1: 4 due to her pre-treatment hCG of >1.5 million IU/L. She received 7 cycles of intramuscular methotrexate from which she achieved and maintained suppressed β-hCG levels (<1 IU/L). Conclusions: This study has demonstrated that the β-hCG levels may not always correlate with disease severity and prognosis.When comparing the two patients Case 1 had lower levels of β-hCG and of free T4 than Case 2, however was clinically more unwell, developed thyroid storm and had metastatic disease. Case 2 had hCG levels almost double those of Case 1, wsa stable and her levels decreased much quicker reaching undetectable levels

Is gynecomastia related to the disease characteristics and prognosis in testicular germ cell tumor patients?

We aimed to assess the relationship between gynecomastia and tumor markers, histologic subtypes, and prognosis in patients with testicular germ cell tumors. This study included 73 testicular germ cell cancer patients with pretreatment chest, abdomen and pelvis computed tomography (CT) scans and tumor markers (β-human chorionic gonadotropin [β-hCG], lactate dehydrogenase [LDH], α-fetoprotein [AFP]). The volumetric analysis of the breast glandular tissue, the presence of gynecomastia and metastatic disease were determined using CT scans. Patients were classified according to the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification. The association between gynecomastia, breast glandular tissue volume, tumor markers, metastatic disease, and disease prognosis were evaluated. Thirty-four of the patients (46.6%) had gynecomastia. A breast volume cutoff value of 0.78 cm3 to diagnose gynecomastia led to 85% sensitivity and 95% specificity. Serum β-hCG level correlated with the breast glandular tissue volume weakly (r=0.242, P = 0.039). Gynecomastia was more common in patients with elevated β-hCG levels (P = 0.047), and was not associated with pulmonary, nonpulmonary distant, or nodal metastases (P = 0.378, P = 0.884, P = 0.333, respectively). No significant association was found between the disease prognosis and gynecomastia (P = 0.556). Gynecomastia was common among testicular germ cell cancer patients with elevated β-hCG. However, it was not associated with metastatic disease and prognosis.

Epithelioid Trophoblastic Tumors: Treatments, Outcomes, and Potential Therapeutic Targets.

Background: Epithelioid trophoblastic tumors (ETTs) are the rarest type of gestational trophoblastic neoplasias. We investigated the clinical features, treatments, outcomes, and prognostic factors in patients with ETT, and explored potential therapeutic targets.Methods: We retrospectively analyzed the clinical features, treatments, survival, and prognostic factors of 21 ETT patients treated at our institution between January 2002 and December 2017. Expression levels of programmed cell death 1 (PD-1), PD-1 ligands (PD-L1and PD-L2), B7 family ligands (B7-H3, B7-H4, V-domain Ig suppressor of T cell activation [VISTA], and B7-H6), and CD105 expression were assessed by immunohistochemistry.Results: Fourteen patients with ETT (66.7%) presented with irregular vaginal bleeding. Three stage I patients (14.3%) with normal β-human chorionic gonadotropin (β- hCG) levels underwent hysterectomy alone. Of the remaining 18 patients who had elevated β-hCG levels (85.7%), 1 received chemotherapy and 17 underwent surgery and multi-agent chemotherapy. After treatment, 17 patients (81.0%) achieved complete remission (2 of whom [11.8%] later relapsed) and 4 (19.0%) with stage IV died of their disease. On univariate and multivariate analyses, stage IV disease was an independent prognostic factor for overall and disease-free survival (P < 0.001). PD-L1, B7-H3, and CD105 were detected in 100% of samples, PD-L2 and VISTA in 82%, B7-H6 in 18%, and B7-H4 was undetectable in ETT cells.Conclusions: Hysterectomy and metastatic lesion resection are essential for controlling ETT. Surgery plus chemotherapy are recommended for patients with abnormal β-hCG levels and metastatic disease. PD-L1, PD-L2, B7-H3, VISTA and CD105 are potential therapeutic targets for metastatic ETT.

EP16.07: Two cases of twin pregnancy with a hydatidiform mole and a coexisting live fetus, especially with high levels of βhCG

Twin pregnancy with a hydatidiform mole and a coexisting live fetus is rare occurrence associated with the increased risk of obstetric complications and poor perinatal outcome. Here we reported two cases of twin molar pregnancy opted for conservative management resulted with unfavourable consequences. The first case is a 31-year-old primigravida woman undergoing in-vitro fertilisation and two embryos transfer. The diagnosis of molar pregnancy was made on ultrasound imaging and elevated levels of βhCG (630,278mIU/mL) at 11 weeks of gestation. She came with abdominal pain, vaginal bleeding, βhCG level greater than 1,000,000mIU/mL, and intrauterine fetal death at 15 weeks of gestation. After termination of pregnancy, the βhCG level normalised after additional 3 courses of chemotherapy. The second case is a 29-year-old primigravida woman in natural conception. At 11 weeks of gestation, she was diagnosed with molar pregnancy by abnormal ultrasound imaging and high levels of βhCG (above 200,000mIU/mL). At 22 weeks of gestation, she came to the hospital with massive vaginal bleeding and the elevated βhCG level up to 896,503mIU/mL. The pregnancy was to be terminated immediately. The βhCG level showed rapid regression and reached normal in 2 months without any treatment. Diagnosis in such cases can be simply made by ultrasound examination and high levels of βhCG. But the decision to continue or terminate pregnancy is always problematic. There are some case reports associated with poor perinatal outcome as shown in our cases. Some authors also report cases of successful delivery of live fetus, but they have relatively lower levels of βhCG. Suksai suggest in the recent meta-analysis that the cut-off value of βhCG is 400,000mIU to enable the pregnancy reaching fetal viability. We propose that the best option may be to terminate the pregnancy when the level of βhCG were extremely high at the time of diagnosis.

Spontaneous Synchronous Bilateral Ectopic Pregnancy

Background: The occurrence of simultaneous ectopic pregnancies in two extrauterine locations is rare, particularly in spontaneous pregnancies. Case: This article describes the case of a 32-year-old woman who presented with persistently elevated β-hCG levels after a salpingectomy for a left ectopic tubal pregnancy. Results: Follow-up elevated β-hCG levels led to the discovery of a simultaneous right tubal ectopic pregnancy. Conclusions: Bilateral ectopic pregnancy is rare but must be suspected when β-hCG is elevated after treatment of an ectopic pregnancy. β-hCG follow-up can be helpful, even if chorionic villi are present in the initial surgical specimen. (J GYNECOL SURG 33:202)

Skeletal Muscle Metastasis and Elevated β-HCG Level Secondary to Tongue Cancer: a Case Report and Review of Literature

Metastases to skeletal muscle and paraneoplastic syndromes involving β-human chorionic gonadotropin (HCG) production are an extremely rare manifestation of head and neck squamous cell carcinoma. We report a patient with a β-HCG-secreting squamous cell carcinoma of the tongue with diffuse metastases involving skeletal muscle. A 47 year old female, who was being treated heavily with palliative chemotherapy for metastatic tongue cancer, was admitted with a palpable thigh mass and pain. A magnetic resonance image showed an intramuscular metastasis in the thigh. Ultrasound-guided biopsy of the thigh mass confirmed metastatic squamous cell carcinoma. She was scheduled for enrollment into a clinical trial; however, a positive serum β-HCG test was noticed. There was no evidence of pregnancy or a trophoblastic or non-trophoblastic tumor secreting β-HCG. Finally, she was revealed to have a paraneoplastic syndrome with diffuse metastases and was ultimately referred for palliative care. We review the literature of previously reported cases of an increase of β-HCG in patients with head and neck cancer. (Korean J Med 2015;89:719-722)

Fatal Choriocarcinoma Syndrome Suspected of Being an Ectopic Pregnancy

Background: Choriocarcinoma is an aggressive, rapidly invasive, and widely metastasizing epithelial malignancy. It may arise from previously normal or abnormal pregnancy. Choriocarcinoma occurrence in a Fallopian tube is a rare event. Case: A 34-year-old para 8+2, woman presented with right iliac fossa pain of 1 day's duration. According to a urine test, she appeared to be pregnant again. Ultrasonography showed a left adnexal mass, but her uterine cavity was empty and she was diagnosed as having an ectopic pregnancy. Intraoperatively, the left broad ligament and infundibulopelvic ligament were dilated and engorged. A left salpingectomy and wedge resection of the broad ligament were performed. Serial preoperative β–human chorionic gonadotropin (β-hCG) level testing during admission increased markedly within 2 days (15,000–752,601 milli–international units [mIU)/mL]). Her postoperative β-hCG level was significantly reduced (225,000 mIU)/mL). A chest radiograph was performed because, preoperatively, she had respiratory distress that was treated as an infection. The radiograph showed bilateral basilar consolidation. She appeared to be recovering well postoperatively but sudden respiratory distress on the ninth postoperative day caused her to collapse, and she died. Results: A postmortem examination revealed that this patient had succumbed to choriocarcinoma syndrome as a result of lung metastasis from a Fallopian tube choriocarcinoma. Conclusions: Albeit its rarity, choriocarcinoma should be considered as one of the possible differential diagnoses of a tubal mass in a patient with an elevated β-hCG level. Early detection is crucial in view of the good prognosis even at an an advanced stage of the disease. (J GYNECOL SURG 30:152)

Intensive chemotherapy followed by reduced-dose radiotherapy for biopsy-proven CNS germinoma with elevated beta-human chorionic gonadotropin

In this study, 10 patients with biopsy-proven germinoma with a beta-human chorionic gonadotropin (β-HCG) level >50 mIU/ml received intensive chemotherapy followed by reduced-dose radiotherapy (RT) to reduce late effects from RT. CSF β-HCG levels were >200 mIU/ml in five patients. After endoscopic or stereotactic biopsy, four cycles of induction chemotherapy were administered prior to RT. A CEB regimen (carboplatin+etoposide+bleomycin) and a CyEB regimen (cyclophosphamide+etoposide+bleomycin) were alternated. No residual tumor remained after induction chemotherapy in six patients, only cystic lesions were present at the primary tumor site in three, and a small solid residual tumor was observed in the remaining patient; however, all these patients had normal β-HCG levels. If complete response was achieved before initiation of RT, 19.5Gy craniospinal RT (CSRT)+10.8Gy local RT was administered to the tumor bed. If residual lesion was suspected, the dose of RT was selected according to the presence/absence of tumor dissemination at diagnosis (19.5Gy CSRT+19.8Gy local RT for localized tumors and 24.0Gy CSRT+16.2Gy local RT for disseminated tumors). Eight patients, including four patients with a β-HCG level >200mIU/ml, received 19.5Gy CSRT. All patients remain disease free at a median follow-up of 58 (range 35-94) months from diagnosis. Our data suggest that pathologically pure germinoma with a significantly elevated β-HCG level might be cured with reduced-dose RT if intensive chemotherapy is provided.

β-Hormone chorionique gonadotrope et cancer bronchique : un piège pour les essais cliniques

Introductionβ-HCG belongs to the glycoprotein hormone family and is usually assess to exclude pregnancy for patients potentially eligible to chemotherapy, especially during clinical trials. Material and MethodsWe studied non-small-cell lung cancer (NSCLC) patients that were found with elevated serum β-HCG level during clinical trial screening. The first case is a 45-year-old woman who presented with a stage IV undifferentiated carcinoma of the lung eligible for chemotherapy. When screening the patient for a clinical trial combining platinum-based chemotherapy and targeted therapy, the plasma β-HCG level was 19 IU/L (0-5 IU/L). The second case is a 64-year-old woman presented with stage IV poorly differentiated adenocarcinoma of the lung. When screening the patient for the same clinical trial combining platinum-based chemotherapy and targeted therapy, the plasma β-HCG level was β-HCG 13 IU/L (0-5 IU/L). ResultsThe serum dosages were double-checked and confirmed elevated β-HCG level. The gynecological work-up definitely rules out an improbable pregnancy. The pathological examination was also checked and confirmed in the two cases a primary lung cancer. An immuno-histochemical reassessment of the pathological specimens with additional tests was performed: for one patient 25% of tumor cells expressed β-HCG. As pregnancies were ruled out, the two cases were extensively discussed with the promoter and the patients finally treated within this clinical trial. The treatments are ongoing. Conclusionsβ-HCG is a specific marker for trophoblastic tumors of placenta and gestational tumors. Ectopic expression of β-HCG was found in 20-40% of all common epithelial carcinoma, especially for tumors of the stomach, ovary, liver and lung. Only few cases have been reported in the literature. However, in a young patient with high serum levels of β-HCG two questions arise: is there a place for pregnancy? Are the pathology results accurate? All this could delay the appropriate management of these patients and also potentially prevents the participation of innovative therapeutic strategies. Therefore, knowing this rare but possible expression of β-HCG by lung tumors may speed out the gynecological work-up and the reevaluation of the histological samples in order to minimize the delay in the care of these patients and give them a chance to have new innovative drugs within clinical trial.

Evaluating methotrexate treatment in patients with low-risk postmolar gestational trophoblastic neoplasia

Objective To identify clinical factors associated with requiring more than a single course of Methotrexate (MTX) to achieve remission among women with low-risk postmolar gestational trophoblastic neoplasia (GTN). Methods We studied 150 women with persistent GTN after diagnosis of complete ( n = 110) or partial mole ( n = 40) to identify possible predictors of requiring additional treatment after a single treatment of methotrexate (MTX). All women had low-risk disease using FIGO and WHO scoring systems. Results Seventy women (47%) required additional courses of chemotherapy, of whom 45 (64%) received chemotherapy other than MTX. Multivariate analysis revealed that complete mole histology, presence of metastasis, single day MTX infusion and any increase in serum beta human chorionic gonadotropin (β-hCG) level 1 week after MTX therapy were independent predictors of requiring additional MTX or alternative chemotherapy. Dilatation and curettage (D+C) within 1 week after the diagnosis of persistence did not affect future chemotherapy requirements ( p > 0.64). Following complete mole, β-hCG levels > 2000 mIU/mL at 1 week post MTX were associated with a 89% risk of additional cycles chemotherapy including MTX and a 65% risk of alternative chemotherapy. Conclusions Metastatic disease, MTX infusion protocol and complete mole histology were independently associated with the need for additional chemotherapy after an initial course of MTX for women with low risk GTN. D+C at persistence did not alter the chemotherapy requirement. Elevated β-hCG level at 1 week after the initial course of MTX was also an independent factor predicting the need for additional courses of MTX or alternative chemotherapy.

Management and outcome of healthy women with a persistently elevated β-hCG

Purpose. Raised serum beta human chorionic gonadotrophin (β-hCG) not due to pregnancy can occur as a consequence of (1) gestational trophoblastic neoplasia (GTN), (2) non-gestational trophoblastic tumours, (3) a false-positive β-hCG, (4) the menopause or (5) a high normal level. Accurate differentiation between these causes is vital to avoid potentially inappropriate investigations and therapies, which may induce infertility or other serious adverse events. Here we report the United Kingdom experience of patients with an elevated β-hCG of initial uncertain cause and provide a clinical algorithm for the management of such cases. Method. The Charing Cross and Weston Park Hospital GTN databases were screened to identify patients referred with an elevated β-hCG who were not pregnant and had no previous diagnosis of GTN. Results. Between 1981 and 2004 fourteen women presented with persistently raised serum β-hCG resulting in diagnostic problems. False-positive β-hCG was excluded in all. Three patients developed gestational choriocarcinoma after 9–29 months. However, in 11 women no cause for the persistently elevated β-hCG was found. One of these achieved chemotherapy-induced normalisation of serum β-hCG, but the remaining 10 underwent surgery and/or chemotherapy without benefit. Thus, 71% (10/14) of patients remain well with unexplained elevated β-hCG levels. Conclusion. Elevated serum and urinary β-hCG levels in healthy women should be investigated systematically to exclude an underlying malignant process and to avoid inappropriate surgical and medical intervention. Long-term follow-up is required as tumours may not become apparent for many months or years.

Epithelioid trophoblastic tumor of the uterus: a report of three cases

Epithelioid trophoblastic tumor of the uterus: a report of three cases

P-459: Should ruptured tubal ectopic pregnancies be managed laparoscopically?

P-459: Should ruptured tubal ectopic pregnancies be managed laparoscopically?