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Case Reports
. 2021 Oct 21:34:101528.
doi: 10.1016/j.rmcr.2021.101528. eCollection 2021.

Beta-HCG secretion by a pulmonary pleomorphic carcinoma: A case report

Magno Dinis de Sousa  1 , Margarida Barata  2 , Ana Raquel Miranda  1 , Pedro Sequeira  3 , Ana Oliveira  3 , Luísa Xavier  1 , Hélder Mansinho  1
Affiliations
Case Reports

Beta-HCG secretion by a pulmonary pleomorphic carcinoma: A case report

Magno Dinis de Sousa et al. Respir Med Case Rep. .

Abstract

Ectopic secretion of beta-subunit of human chorionic gonadotropin (β-HCG) in pulmonary pleomorphic carcinoma is remarkably rare. Such unusual ectopic hormone production by lung cancer may be initially misinterpreted as extragonadal choriocarcinoma or germ cell tumor. We report a 56-year-old postmenopausal female, smoker, who presented a 5-month history of progressive dyspnea, dry paroxysmal cough, and significant weight loss. She was referred by a local hospital with the preliminary diagnosis of gestational trophoblastic neoplasia due to a rapidly growing thoracic tumor with persistently elevated serum β-HCG. Computed tomography of the chest showed a lung mass in the right upper lobe associated with homolateral pleural effusion. Positron emission tomography showed pathological 2-[18F]FDG uptake at the mass lesion. Biopsies were performed. Histological examination described pleomorphic carcinoma with positive immunostaining for β-HCG. The serum levels of β-HCG were also elevated indicating ectopic secretion. The patient had rapid clinical deterioration and deceased before chemotherapy initiation. Only a few cases of paraneoplastic β-HCG secretion have been reported in the literature. Previous studies suggested that the ability to secrete β-hCG in tumors may correlate to some extent to chemoresistance; thus, it might be useful as a prognosis marker.

Keywords: Beta subunit; Chorionic gonadotropin; Lung neoplasms; Paraneoplastic syndromes; Pleomorphic carcinoma; Sarcomatoid carcinoma.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Chest CT showing a lung mass in the right upper lobe associated with large homolateral pleural effusion.
Fig. 2
Fig. 2
PET/CT scan showing high FDG uptake at a lesion in the upper lobe of the right lung and a smaller lesion in the lower lobe of the left lung.
Fig. 3
Fig. 3
Pleomorphic carcinoma comprising an undifferentiated non-small cell carcinoma component with large, pleomorphic cells (A and B) and rare giant multinucleated cells (B) admixed with a fusocelular component (H&E staining at 200x magnification).
Fig. 4
Fig. 4
Immunohistochemistry (IHC) images showing CKAE1AE3 expression (A) and β-HCG expression (IHC at 200x magnification).
See this image and copyright information in PMC

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