Galactorrhea, mastodynia and gynecomastia as the first manifestation of lung adenocarcinoma. A case report

Abstract

Gynecomastia with mastodynia and galactorrhea as a paraneoplastic syndrome due to lung cancer with complete response after surgical excision is rare.A 62-year-old Caucasian male presented with mastodynia, galactorrhea and right breast enlargement. Chest x-ray revealed a left upper lobe tumor. The patient had high levels of serum beta-human chorionic gonadotropin (b-HCG) and prolactine. Complete staging was negative for metastases.A typical left upper lobectomy with radical mediastinal lymph node dissection was performed. Pathology report was consistent with a poorly differentiated adenocarcinoma (T2N1M0). Immunohistochemically, multinucleate cells and occasional mononucleate tumor cells showed positivity for human chorionic gonadotropin.The patient received adjuvant chemotherapy with cisplatin – navelbine. One year later physical examination showed regression of both gynecomastia and mastodynia and there was no nipple discharge, while he is free from local or distant metastatic disease and the b-HCG level is normal (1,59 mIU/ml).This case represents a very rare, first manifestation of lung cancer. Galactorrhea, mastodynia and gynecomastia were the initial symptoms, which totally resolved following the successful surgical resection and adjuvant chemotherapy. In this case, prolactin and b-HCG are useful biomarkers during follow up for checking local or distal recurrence of the disease.

Elevated beta human chorionic gonadotropin in a non-pregnant female diagnosed with anal squamous cell carcinoma

“…There have been case reports in a variety of malignancies of patients presenting with an elevated serum β-hCG. This has been documented in cancers including breast, 11 cervical, 12,13 gallbladder, 14,15 gastric, 16 head and neck, 17 lung, 18–21 ovarian, 22,23 renal cell, 24 sarcoma 25–28 and urothelial, 29 and in both male and female patients. In our case, the elevated level of β-hCG is probably attributable to ectopic excretion by the SCC tumour in the anus.…”

Treatment of gynecomastia with prednisone: case report and literature review

“…18 Prolactin is a hormone with multiple biological actions and it is synthesized by the anterior pituitary gland. 19 However, ACTH production by the pituitary tumor and modest hyperprolactinemia may develop because of adrenocortical insufficiency; however, prolactin production because of primary adrenal insufficiency is rare. 20 Adrenal insufficiency should be considered to be a very rare cause in the differential diagnosis of hyperprolactinemia.…”

"Unusual Manifestation of Ectopic Human Chorionic Gonadotropin-Producing Cancers"

“…Bladder urothelial carcinoma [11][12][13] Breast malignant phyllodes tumor [14] Cervix squamous cell carcinoma [15] Gallbladder adenocarcinoma [16,17] Head and neck squamous cell carcinoma [18,19] Kidney renal cell carcinoma [20] Lung non-small-cell adenocarcinoma [21][22][23][24][25] Ovary mucinous adenocarcinoma [26,25] Stomach gastric adenocarcinoma [27,28] Sarcomas leiomyosarcoma, liposarcoma, rhabdomyosarcoma [29][30][31][32]…”

“…In reproductive-aged women with elevated hCG, when pregnancy, either normal of abnormal (e.g. missed abortion, ectopic pregnancy)) is excluded, the malignancy should [18][19][20][21][22][23][24] be ruled out with imaging and surgical specimen immunohistochemically.…”