Endocrine Abstracts

A 57-year-old woman was referred due to elevated urine & serum human chorionic gonadotrophin (β-hCG) concentrations found at routine pre-operative assessment. She was asymptomatic and was not pregnant. Her past history included a long standing benign 7 cm×5 cm myofibroblastic mass in her left forearm asthma, rotator cuff tear and a uterine fibroid. Her medications were cyclical norethisterone, lansoprazole, frusemide & inhalers. The left forearm mass was not associated with any neuromuscular or vascular compromise. Clinically, she was eupituitary with intact visual fields. Her serum β-hCG level was elevated to 202 IU/l (non-pregnant values <5 IU/l) and serial dilutions as well as PEG precipitation had shown no evidence of analytical interference. Her pituitary profile was normal other than slightly raised gonadotrophins (FSH 27 IU/l (post menopausal range >30 IU/l), LH 21 IU/l (post menopausal range >30 IU/l) and oestradiol 145 pmol/l (post menopausal range <183 pmol/l). A CT Chest, Abdomen & Pelvis and MR pelvis only showed multiple benign fibroids with no suggestion of a germ cell tumour. Endometrial biopsy showed no evidence of malignancy. MR left forearm done at yearly intervals over 3 years showed a stable soft tissue mass encasing the anterior & posterior compartment. An initial biopsy was suggestive of benign mesenchymal lesion. β-hCG staining carried out 3 year later was positive. Ki67 showed no proliferation.

Discussion: β-human chorionic gonadotrophin is chiefly produced by the placental trophoblasts & is mainly used to diagnose pregnancy. Ectopic β-hCG can also be elevated in certain conditions such as pituitary human chorionic gonadotropin (hCG) production, trophoblastic disease, choriocarcinoma, teratomas, germ cell tumours, and sarcomas. β-hCG is also described in literature as an oncogene and depicts worse outcomes in colorectal cancers. As a tumour marker it is also used for its prognostic value and monitoring of therapeutic response to treatment. Ectopic β-hCG secretion has rarely been reported in benign mesenchymal tumours and usually seen in more high grade sarcomas. Excisional surgery in this case would result in major loss of function of her left arm due to extensive locally invasive nature. Thus it is currently being monitored with regular scans. Whether β-hCG positivity in the absence of local proliferation and distant malignant disease and should prompt surgery remains to be determined.