hCG production by mucinous adenocarcinoma of the ovary in a reproductive aged woman

Abstract

When elevated serum hCG is discovered during the work up of a gynecologic tumor, it is paramount to identify the source of hCG prior to initiation of treatment. Potential sources of hCG include viable intrauterine pregnancy, ectopic pregnancy, miscarriage, gestational trophoblastic disease, pituitary hCG production, phantom hCG (heterophilic antibody interference), and tumor production. Here, we present a case of elevated hCG in a young women with a large complex pelvic mass. Prior to treatment initiation, the patient underwent work up for hCG elevation, which was ultimately found to be from tumor production. Pathologic examination revealed the mass to be a mucinous adenocarcinoma of the ovary with aberrant expression of hCG, rather than the more typical hCG producing germ cell tumor. We detail the preoperative evaluation process of hCG elevation. Additionally, we discuss the role of hCG in ovarian cancer and influence on tumorigenesis and management.

Mucinous Cancer of the Ovary: Overview and Current Status

“…Free B-hCG might be infrequently overexpressed in epithelial ovarian carcinoma, including MOC [35]. In a pre-clinical module, overexpression of hCG was shown to induce tumor development, increase cell proliferation, induce cell cycle progression, and downregulate apoptosis [36].…”

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.…”

"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]…”

“…Pituitary hCG is naturally produced at extremely low levels in woman of reproductive age population. In peri-or postmenopausal state, levels of pituitary hCG increase because of the absence of feedback control by circulating estrogen and progesterone [2,[25][26][27][28][29][30][31][32]. Elevated ß-hCG level due to various cancers produce excessive amounts of estradiol by peripheral aromatase activation, which can manifest as gynecomastia in males or vaginal spotting in females.…”