Ectopic production of the immunoreactive β‐subunit of human chorionic gonadotropin (IR‐hCGβ) by gynecologic malignancies has been well recognized, but IR‐hCGβ has not yet been established as a clinically useful tumor marker, except for germ cell tumors. We measured the concentrations of IR‐hCGβ‐related molecules, intact hCG, free hCGβ, and β‐CF, in the sera and urine of patients with various gynecologic cancers (cervical, endometrial, and ovarian cancers) to assess their clinical usefulness as a tumor marker in comparison with serum tumor markers such as CEA, SCC, CA125, and CA19‐9. The highest incidence of IR‐hCGβ was obtained in tbe assay for β‐CF in the urine, with positive rates of 47.7% (94 of 197) for cervical, 37.8% (14 of 37) for endometrial, and 84.4% (38 of 45) for ovarian cancers with a cut‐off value of 0.2 ng/mg of creatinine. In cervical cancer, there was no significant correlation between the concentrations of urinary β‐CF and serum SCC, and 57.9% (114 of 197) of the patients were detected by the combination assay of these tumor markers. Serial determination in 22 cervical cancer patients with elevated urinary β‐CF level prior to therapy showed that its level decreased after successful treatment, but 4 of 5 patients with persistent or recurrent disease had elevated levels of urinary β‐CF. All of the ovarian cancer patients examined were detected by the combination assay of urinary β‐CF and serum CA125. The levels of urinary β‐CF showed little correlation with those of the serum tumor markers, indicating the usefulness of the combination assay of urinary β‐CF with serum tumor markers for detecting cervical and ovarian cancers.

We analyzed immunoreactive hCG/hCGbeta (IR-beta) in the sera and urine of patients with trophoblastic diseases and non-trophoblastic tumors by using enzyme immunoassays (EIAs) specific for intact hCG, free hCG beta, and beta-core fragment of hCG (beta-CF). In trophoblastic diseases, while intact hCG and free hCGbeta were contained in both serum and urine, the beta-CF could be detected only in the urine of the patients. The relative contribution of the beta-CF to the total urinary IR-beta accounted for about 30-50% in normal early pregnancy and hydatidiform mole, and more than 60% in choriocarcinoma. We conclude that intact hCG should be measured in the serum rather than in the urine as a tumor marker for trophoblastic diseases, and suggested that the ratios of intact hCG, free hCGbeta, and beta-CF to each other may be useful indices in the differential diagnosis of trophoblastic diseases. Ectopic IR-beta was also investigated in the sera and urine of the patients with cervical, endometrial, ovarian, lung, and bladder carcinomas. We found that even when IR-beta could not be detected in the serum, the urine of the same patients with cancer often contained the significant amounts of IR-beta. The chromatographic study indicated that these urinary IR-beta were essentially attributed to beta-CF, leading to the evaluation of urinary beta-CF as a tumor marker. The positive rated of urinary beta-CF were 48% for cervical, 38% for endometrial, and 84% for ovarian, 40% for lung, and 42% for bladder carcinomas. We conclude that ectopic production of hCG beta by non-trophoblastic tumors is not a rare phenomenon and it can be recognized as a tumor marker when beta -CF is measured in urine of the patients.

Spontaneous thrombosis of the pampiniform plexus is a extremely rare condition, with only 9 cases reported in the literature. We report here a case of this entity and demonstrate that surgical exploration should be indicated to rule out some of these other conditions, such as a tumor of the intrascrotal component, acute scrotum or inguinal herniation.

The present results suggested that ectopic production of IR-hCG beta by bladder carcinoma is not rare phenomenon and it is clinically useful as a tumor marker when beta-CF is measured in the urine.