Endocrine Abstracts

Beta-human chorionic gonadotropin (β-hCG) is normally produced by syncytiotrophoblasts of the placenta and may also be secreted by germ cell neoplasms. An increase of serum hCG concentration in a male patient often suggests malignant neoplasms with a trophoblastic element. Common examples include classic seminoma with syncytiotrophoblast-like giant cells, combined germ cell tumour, and choriocarcinoma. Non-gestational choriocarcinomas typically arise from gonadal organs but they may originate in extragenital sites such as the mediastinum, retroperitoneum, pineal gland, liver, gallbladder, and urinary tract. Ectopic secretion of β-hCG is associated with a poorer prognosis. We present a 50 year old man who was referred to endocrine clinic with painful gynaecomastia of 3 months duration. He was waiting hip replacement. He had history of a lump in his left breast 9 years ago. He had USS and FNA. He was treated with some tablets for a month and discharged from breast clinic. He had no other past medical history. He worked as a physical trainer to metropolitan police. He did not smoke or drink and was on no medication. He had never used recreational drugs. His BMI was 26 kg/m². Examination and USS confirmed bilateral gynaecomastia. USS of the testes was normal with a small hydrocele on the left side. His blood tests showed FSH of <0.1 (1–10 IU/l), LH <0.1 (2–9 IU/l), testosterone 36.2 nmol/l (6.68–25.70), oestradiol 354 pmol/l (99–192), SHBG 44 noml/l (20.6–76.7) and his HCG was 250 IU/L (0–2). CT thorax, abdomen and pelvis was reported to be normal. His whole body bone scan was normal. His Repeat HCG in 6 weeks was 1265 and subsequently in 3 months increased to 3756. He underwent NM Whole body FDG PET CT which raised suspicion of an aggressive lesion in the anterior mediastinum with metastatic deposits in the lung. Mediastinal biopsy showed no unequivocal evidence of malignancy and a panel of immunohistochemical stains was not contributory. He had elective left anterior mediastinotomy +-VATS. Anterior mediastinal mass biopsies confirmed choriocarcinoma.