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Case Reports
. 2024 Jan 27:2024:8731806.
doi: 10.1155/2024/8731806. eCollection 2024.

Beta-HCG Secretion by a Pulmonary Choriocarcinoma in a Male Patient

Brecht Devos  1 , Cedric Willemse  2 , Mira Sterckx  3 , Johan Debruyne  1 , Inge Stappaerts  3 , Tom Van den Mooter  4 , Marjan Hertoghs  5 , Pascale Abrams  2
Affiliations
Case Reports

Beta-HCG Secretion by a Pulmonary Choriocarcinoma in a Male Patient

Brecht Devos et al. Case Rep Oncol Med. .

Abstract

Background: Paraneoplastic secretion of beta-subunit of human chorionic gonadotropin (β-HCG) in pulmonary carcinoma is rare. Case Presentation. A 65-year-old man presented with bilateral gynaecomastia with abnormally high levels of β-hCG and elevated oestradiol, progesterone, and testosterone levels on April 7, 2023. After excluding testicular malignancy, CT scan of the chest and abdomen revealed bilateral pulmonary lesions. Transthoracic biopsy confirmed malignancy with choriocarcinoma. MRI of the brain showed a solitary brain metastasis, while on a subsequent 18F-FDG PET/CT, no other metastatic lesions were seen. The patient was treated with chemoimmunotherapy carboplatin-etoposide-pembrolizumab with good partial response.

Conclusion: Our case of a presumably stage IV dedifferentiated mNSCLC presenting as an extragonadal β-hCG secreting pulmonary choriocarcinoma is a very rare tumor with a poor prognosis. Its biology, origin, and treatment remain to be elucidated. Cancer genome sequencing is necessary for the identification of the origin and seeking treatment.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
(a) A computed tomographic scan of the chest showing the 3 pulmonary masses with the largest mass located posteriorly in the right lower lobe. (b) MRI of the brain (T2-weighted axial image) showing the solitary brain metastasis consisting of a 2.7 cm nodular component with perilesional edema and hemorrhagic characteristics: susceptibility artifacts with foci of signal loss on T2-gradient echo sequence in the peripheral part of the nodule. (c, d) 18F-FDG PET/CT showing FDG avidity and extent of the bilateral pulmonary tumoral sites with physiologic uptake in the urinary tract.
Figure 2
Figure 2
Histologic and IHC findings. (a) Malignant tumor with extensive necrosis, mostly composed of large tumor cells with enlarged hyperchromatic nuclei and eosinophilic to clear cytoplasm (hematoxylin and eosin stain, ×20). (b) HCG is immunopositive in the cytoplasm of tumor cells (×20). (c) SALL-4 is positive in the nucleus of most tumor cells (×20). (d) GATA-3 is firmly nucleus positive in mononuclear trophoblast cells (×20). (e) P40 are nucleus positive in mononuclear trophoblast cells (×20). (f) CK pan is diffused and strongly positive in the cytoplasm of tumor cells (×20). (g) TTF-1 IHC is negative in the tumor cells (×20). (h) D2-40 is negative in the tumor cells (×20). HCG: human chorionic gonadotropin; GATA-3: anti-GATA3 antibody; CK pan: pankeratin; TTF-1: thyroid transcription factor 1.
Figure 3
Figure 3
Human chorionic gonadotropin (HCG) levels. Day 0 represents the start of the chemoimmunotherapy.
See this image and copyright information in PMC

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