Discordant Human Chorionic Gonadotropin Results Giving Rise to Inappropriate Therapy in a Case of Testicular Cancer

Abstract

The most widely cited cause of a falsely elevated human chorionic gonadotropin level in patients with germ cell tumors is an elevated level of partially cross-reacting luteinizing hormone. Other causes of discordant human chorionic gonadotropin results (human chorionic gonadotropin elevated in 1 assay but normal in others) in testicular cancer have received scant attention. A patient with pure seminoma was given inappropriate chemotherapy on the basis of an elevated human chorionic gonadotropin level, later shown to be due to a nonspecific serum interfering substance. A discordant human chorionic gonadotropin result should be suspected when the human chorionic gonadotropin is only modestly elevated, there is no serial increase in the human chorionic gonadotropin level and no other evidence of tumor can be found.

Analysis of hCG: Clinical Applications and Assay Requirements

“…Discrepancies in results can be due to a number of other causes, 10.911.91 some of which are listed in Table 8 (refs [92][93][94][95][96][97][98][99][100][101][102][103], where they are classified according to whether they relate primarily to the nature of the individual specimen (endogenous Anti-reagent antibodies. Falsely high or low results may be obtained for patients' serum samples containing anti-immunoglobulin G (anti-IgG) antibodies capable of reacting with the antibodies used in the assay.…”

Marqueurs tumoraux et tumeurs germinales du testicule

“…Les élévations non spécifiques des taux sériques d'hCG ou d'hCGβ libre sont multiples et sont trouvées dans 0,5 % à 3 % des échantillons (41), conduisant parfois à des traitements (orchidectomie, chimiothérapie) non nécessaires (42,43). La cause la plus fréquente d'élévation non spécifique d'hCG chez les patients avec une tumeur testiculaire est une élévation partielle due à une réaction croisée avec la hLH des anticorps utilisés pour doser l'hCG.…”