Human chorionic gonadotropin detected in urinary concentrates from patients with malignant tumors of the testis, prostate, bladder, ureter and kidney

False positive hCG testing and upper urinary tract infection

OBJECTIVES

Human chorionic gonadotropin (hCG) assays are commonly used as a pregnancy test. False-positive human chorionic gonadotropin (hCG) values in urine were reported in 15 patients (nine males and six females) presenting with urinary tract infection.

METHODS

Extopic hCG production and presence of heterophilic antibodies were excluded as potential causes of interference.

RESULTS

Orbitrap mass spectrometry revealed the presence of uromodulin, an abundant urinary glycoprotein, as the likely cause of the interference. Falsely elevated hCG values correlated well with urinary alpha 1 microglobulin (a tubular protein) concentrations and with the urinary leukocyte count. The false positive hCG signal disappeared after antibiotic administration.

CONCLUSIONS

These data suggest that false-positive hCG test results in urine may occur in patients presenting with upper urinary tract infections due to uromodulin interference.

Rapid β-human chorionic gonadotropin detection in urine with electric-double-layer gated field-effect transistor biosensors and a handheld device

In this experimental study, a portable biosensor was developed to detect β-human chorionic gonadotropin (β-hCG), which is extensively used in pregnancy tests and serves as a biomarker for ectopic pregnancy. The sensor used is an electric-double-layer field-effect transistor biosensor with the extended-gate design. Bias voltage is applied on the sensor to measure the resulting drain current signals. Gold electrode surface is functionally activated with an anti-β-hCG antibody to capture β-hCG protein. Fluorescence imaging technique is utilized to confirm the surface functionalization. The biosensor demonstrates a dynamically wide range of molecules as detection targets at very low sample concentrations, which shows the potential to detect ectopic pregnancy in very early stages and easily keep track of its periodic changes. It can be produced en masse and does not use additional labels/reagents or pre-processing techniques for the sample. This biosensor can significantly reduce the manufacturing costs and is comparable with the currently available commercial ß-hCG assays. It is suitable for early diagnosis of ectopic pregnancy with low cost and easy operation at home with urine samples.

The Role of Human Chorionic Gonadotropin as Tumor Marker: Biochemical and Clinical Aspects

Tumor markers are biological substances that are produced/released mainly by malignant tumor cells, enter the circulation in detectable amounts and are potential indicators of the presence of a tumor. The most useful biochemical markers are the tumor-specific molecules, i.e., receptors, enzymes, hormones, growth factors or biological response modifiers that are specifically produced by tumor cells and not, or minimally, by the normal counterpart (Richard et al. Principles and practice of gynecologic oncology. Wolters Kluwer Health, Philadelphia, 2009). Based on their specificity and sensitivity in each malignancy, biomarkers are used for screening, diagnosis, disease monitoring and therapeutic response assessment in clinical management of cancer patients.This chapter is focused on human chorionic gonadotropin (hCG), a hormone with a variety of functions and widely used as a tumor biomarker in selected tumors. Indeed, hCG is expressed by both trophoblastic and non-trophoblastic human malignancies and plays a role in cell transformation, angiogenesis, metastatization, and immune escape, all process central to cancer progression. Of note, hCG testing is crucial for the clinical management of placental trophoblastic malignancies and germ cell tumors of the testis and the ovary. Furthermore, the production of hCG by tumor cells is accompanied by varying degrees of release of the free subunits into the circulation, and this is relevant for the management of cancer patients (Triozzi PL, Stevens VC, Oncol Rep 6(1):7-17, 1999).The name chorionic gonadotropin was conceived: chorion derives from the latin chordate meaning afterbirth, gonadotropin indicates that the hormone is a gonadotropic molecule, acting on the ovaries and promoting steroid production (Cole LA, Int J Endocrinol Metab 9(2):335-352, 2011). The function, the mechanism of action and the interaction between hCG and its receptor continue to be the subject of intensive investigation, even though many issues about hCG have been well documented (Tegoni M et al., J Mol Biol 289(5):1375-1385, 1999).

Gonadotropins and prostate cancer: revisited

Luteinizing hormone and follicle-stimulating hormone are called gonadotropins, because they stimulate the gonads - in males the testes and in females the ovaries. They are not necessary for life, but are essential for reproduction. In addition, the association of these hormones with prostate cancer has been the interest of many researchers. Their detection in the human prostate has been investigated using different methods, including immunologic and RT-PCR techniques. In addition, the increasing evidence of paracrine/autocrine functions of the gonadotropic glycoprotein hormones, their allocation to the superfamily of cystine knot growth factors, and luteinizing hormone/chorionic gonadotropin receptor gene expression in non-gonadal tissues led many researchers to investigate intraprostatic glycoprotein hormones and their receptor gene expression. We aim in this review to shed light on the physiology of the gonadotropins and their association with prostate cancer and highlight the future possibilities of their use as targets in treating this disease.

Human chorionic gonadotropin beta (HCGbeta) down-regulates E-cadherin and promotes human prostate carcinoma cell migration and invasion

BACKGROUND

Membrane-associated human chorionic gonadotropin beta (HCGbeta) is correlated with a poor prognosis in localized prostate adenocarcinoma. The relationship between HCGbeta and metastasis, however, is unclear.

METHODS

To shed some light on the issue, two stable prostate carcinoma cell lines overexpressing HCGbeta, designated DU145 HCGbeta and PC3 HCGbeta, were created and compared with empty vector stably transfected DU145 and PC3 cells (control cells).

RESULTS

HCGbeta expression resulted in a change in morphology; the cells were more elongated and had multiple pseudopodia, while the control cells were more rounded. This change in morphology was duplicated by incubating control cells in conditioned medium from the DU145 HCGbeta or PC3 HCGbeta cells, or by adding purified HCGbeta to control medium. The DU145 HCGbeta and PC3 HCGbeta cells were also less adherent than the controls, as assessed by the ease with which trypsin-EDTA could remove them from culture plates. Reduced adherence could be duplicated by incubation of control cells with either conditioned medium or purified HCGbeta. Western blot analysis showed that DU145 HCGbeta and PC3 HCGbeta cells expressed less E-cadherin than control cells and that a change of medium increased expression of E-cadherin. Addition of conditioned medium, or purified HCGbeta, to control cells down-regulated E-cadherin. Cell migration and invasion assays showed that DU145 HCGbeta and PC3 HCGbeta cells were more migratory and invasive than controls and that treatment of control cells with either conditioned medium or purified HCGbeta increased their migratory/invasive capacity.

CONCLUSION

The data indicate that HCGbeta is directly responsible for changes in prostate carcinoma cells associated with an increased metastatic phenotype.

Detection of Human Chorionic Gonadotrophin-β in Serum or Urine of Prostate Cancer Patients Is of No Clinical Significance

The aim of this study was to prospectively evaluate the potential role of elevated urinary/serum human chorionic gonadotrophin-beta (hCGbeta) in prostate cancer prognosis. 104 patients with newly diagnosed prostate cancers were included; 68 patients had organ-confined, 18 had locally advanced and 18 had metastatic disease. A control group consisted of 115 patients presenting with benign prostatic disease. Serum and urinary total hCGbeta was measured prior to treatment and serum PSA was measured at diagnosis. The patients were treated along conventional lines and progression-free survival was assessed. Four patients had elevated serum and 10 had elevated urinary, total hCGbeta. There were no significant correlations between serum/urinary levels of hCGbeta and tumour stage, Gleason score or PSA. In contrast, serum PSA had significant linear correlations with both clinical tumour stage and Gleason score (p = 0.0001). At a median follow-up of 36 months, 22 (21.2%) patients had died while 17 (16.3%) others had progressed. Kaplan-Meier plots and log-rank test revealed no significant difference in progression-free survival between patients with elevated or normal levels of serum and/or urinary total hCGbeta. Clinical tumour stage, grade and PSA were statistically significant prognostic variables. Immunoassay measurement of serum or urinary hCGbeta has no significant role in the clinical management of prostate cancer.

Human chorionic gonadotropin in cancer

Human chorionic gonadotropin (hCG) is mainly used for detection and monitoring of pregnancy and pregnancy-related disorders but it is also an extremely sensitive and specific marker for trophoblastic tumors of placental and germ cell origin. Thus treatment of relapsing choriocarcinomas and testicular germ cell tumors is often initiated on the basis of rising hCG levels even in the absence of clinical or histological evidence of a relapse. While these tumors mostly produce the intact heterodimeric hormone consisting of an alpha (hCGalpha), and a beta subunit (hCGbeta), many nontrophoblastic tumors produce only hCGbeta This is usually a sign of aggressive disease and elevated serum levels of hCGbeta are strongly associated with poor prognosis. Elevated serum levels are observed in 45-60% of patients with biliary and pancreatic cancer and in 10-30% of most other cancers. Methods that detect hCG and hCGbeta together are mainly used for measurement of hCG-like immunoreactivity in serum. However, the reference range for hCG is 5-8 fold higher than that for hCGbeta and thus moderately elevated levels can be identified only with a specific and sensitive hCGbeta assay.

Inhibition of human chorionic gonadotropin beta-subunit modulates the mitogenic effect of c-myc in human prostate cancer cells

BACKGROUND

Amplification of the proto-oncogene c-myc has been identified as one of the most common genetic alterations in prostate cancer, thus making it an attractive therapeutic target. However, certain prostate cancer cells are unresponsive to c-Myc inhibition. The purpose of this study was to test the hypothesis that effective growth inhibition in the refractory cancer cells can be achieved by blocking c-myc along with a growth factor using a novel phosphorodiamidate morpholino antisense oligomer-based approach. Human chorionic gonadotropin, a growth factor implicated in neoplasm, causes activation of c-myc through a G-protein-coupled pathway of signal transduction.

METHODS

In this study, the effect of inhibition of beta-hCG and c-myc singly or in combination was evaluated in DU145 (RB -/-, p53-/-, androgen-independent) and LNCaP (Rb+/+, p53 +/+, androgen-sensitive) human prostate cancer cell lines and in a DU145 subcutaneous xenograft murine model.

RESULTS

Antisense phosphorodiamidate morpholino oligomers directed against beta-hCG and c-myc caused a specific decrease of the target protein levels. Unlike LNCaP cells, DU145 cell growth was refractory to c-Myc inhibition. Unresponsiveness to c-myc inhibition in DU145 cells was overcome by targeting both beta-hCG and c-myc genes, resulting in potentiation of the antiproliferative effect seen with inhibition of beta-hCG alone.

CONCLUSIONS

The inhibition of beta-hCG sensitizes prostate cancer cells to the antiproliferative effects of c-Myc inhibition, including tumors that are refractory to c-Myc decrease alone.

Urine: beyond cytology for detection of malignancy

In the present review we discuss various ancillary modalities for detection of malignancies in urine samples, with an emphasis on urothelial carcinomas. Flow cytometry, bladder tumor antigen (BTA), nuclear matrix protein (NMP), matrix metalloproteinase (MMP), human chorionic gonadotrophic (HCG), telomerase, and other techniques are discussed. DNA FCM is a relatively costly and sophisticated technique. It has a practical application in the diagnosis of bladder cancer among subjects at high risk and is of value in monitoring the course of the disease and anticipating recurrence following conservative treatment. The BTA test is a simple, rapid, and inexpensive adjunct to cystoscopy and the results of the test are equivalent or superior to those of voided urinary cytology. NMP-22 immunoassay is a useful diagnostic test for predicting recurrence of urothelial malignancy. It is also a cost-effective and sensitive screening test for detecting tumor in patients with urothelial carcinoma. Beta-HCG estimation in urine samples appears to be an efficient diagnostic marker for the assessment of distant metastasis in bladder carcinoma rather than a screening test. Other ancillary techniques such as detection of expression of cytokeratin 20 by RT-PCR, MMP-9 estimation, and fluorescent in situ hybridization and telomerase activity are rarely applied clinically in routine urinary samples and are not cost-effective.

The free beta-subunit of human chorionic gonadotropin as a prognostic factor in renal cell carcinoma

The free beta-subunit of human chorionic gonadotropin beta is expressed in several nontrophoblastic tumours and this is usually associated with aggressive disease. Little is known about human chorionic gonadotropin beta expression in renal cancer. We determined the pretreatment levels of human chorionic gonadotropin beta in serum of patients with renal cell carcinoma, and studied whether elevated levels predicted the clinical outcome. Serum samples were collected before surgery from 177 patients with renal cell carcinoma and from 84 apparently healthy controls. Human chorionic gonadotropin beta in serum was measured by a highly sensitive time-resolved immunofluorometric assay. The prognostic value of human chorionic gonadotropin beta, and of usual clinical and pathological variables was analyzed by the Kaplan-Meier method, the log rank test and Cox multiple hazard regression. The serum concentrations of human chorionic gonadotropin beta were increased in 23% of the renal cell carcinoma patients and they were significantly higher in patients with renal cell carcinoma than in controls (P<0.0001). The concentrations did not correlate with clinical stage and histopathological grade, but patients with increased human chorionic gonadotropin beta levels had significantly shorter survival time than those with levels below the median (cut-off 1.2 pmol l(-1), P=0.0029). In multivariate analysis human chorionic gonadotropin beta, tumour stage and grade were independent prognostic variables. The serum concentration of human chorionic gonadotropin beta is an independent prognostic variable in renal cell carcinoma. The preoperative value of human chorionic gonadotropin beta in serum may be used to identify patents with increased risk of progressive disease.

Pathophysiological importance of various molecular forms of human choriogonadotropin

Human chorionic gonadotropin (hCG), its subunits and fragments are widely used for diagnostic purposes. In addition to the diagnosis of pregnancy and pregnancy related disorders, hCG determinations are used for diagnosis of trophoblastic and recently also nontrophoblastic tumors. The use for diagnosis of nontrophoblastic tumors requires highly specific and ultrasensitive assays. With these, it is possible to measure the concentrations of both hCG, the free beta-subunits and the so called beta-core fragment in healthy subjects. Therefore it is important to establish reference values for these and also to be aware of the influence of physiological factors on the serum and urine concentrations. Improved standardization of the assay methods is also essential for these novel applications of hCG determinations to become useful.

beta hCG as a prognostic marker in adenocarcinoma of the prostate

AIMS

To assess the importance of immunohistological detection of beta-human chorionic gonadotrophin (beta hCG) in localised prostatic adenocarcinoma with regard to prognosis and clinical applications.

METHODS

Eighty consecutive cases of clinically localised adenocarcinoma of the prostate were studied retrospectively. Immunohistological analysis on formalin fixed, paraffin wax embedded prostate tissue from transurethral resections was related to clinical outcome and survival. Prognosis was also related to tumour grade.

RESULTS

beta hCG was detected in 12 cases. Nine of these patients were found to have metastases (75%) at follow up and 11 (92%) were dead within 18 months. There was no correlation with grade and prognosis in this group. Of the 68 beta hCG negative cases, 21 had developed metastases (31%) and 25 (37%) had died within 18 months. In the beta hCG negative group there was an association between histological grade and survival.

CONCLUSION

The demonstration of beta hCG in prostatic adenocarcinoma identifies a group of patients with poor prognosis, irrespective of histological grade. This additional information will be extremely valuable in the subsequent clinical management of such patients.

Human chorionic gonadotropin in serum and neoplastic tissue from patients with bladder carcinoma

Serum levels and tissue expression of beta subunit of human chorionic gonadotropin were determined in 25 patients with bladder carcinoma. Elevated gonadotropin levels in serum were observed in 5 (20%) patients and immunoreactive cells were found in 5 (20%) tumours. The correlation was poor between serum level and immunohistochemical gonadotropin status. Only one patient showed both elevated serum level and immunohistochemical gonadotropin expression. Our observations suggest that elevated serum levels of gonadotropin may be an indicator of poor prognosis. However, immunohistochemical expression of gonadotropin did not seem to have a similar impact on prognosis in this series.

Prognostic value of beta human chorionic gonadotrophin in blood serum of patients with urinary bladder tumours

Beta human chorionic gonadotrophin levels have been assessed in blood serum of 79 patients with bladder tumours before and seven days after transurethral electroresection (TUR). With the growth grade of anaplasia and staging the mean serum beta HCG level increased. Beta HCG was a good biological marker to differentiate between superficial and deep tumours.

Ectopic human chorionic gonadotrophin (HCG) production: is the detection by serum analysis of HCG of clinical relevance in transitional cell carcinoma of the bladder?

OBJECTIVE

To assess the potential value of ectopic beta-human chorionic gonadotrophin (beta HCG) measurement in the clinical management of transitional cell carcinoma (TCC).

PATIENTS AND METHODS

A prospective serological study of 163 consecutive patients undergoing cystoscopy as new or review cases was performed to assess any correlation between beta HCG production and histological grading or stage.

RESULTS

Ten per cent of patients with TCC had a raised beta HCG level but there was no correlation with tumour differentiation, staging or prognosis.

CONCLUSIONS

beta HCG has no role as a tumour marker for TCC and therefore appears unlikely to play a part in the clinical management or treatment of urothelial tumours.

Is beta-human chorionic gonadotrophin production by transitional cell carcinoma of the bladder a marker of aggressive disease and resistance to radiotherapy?

The biopsies from 75 patients with transitional cell carcinoma of the bladder (25 Ta-T1; 45 T2-T4, 5M) were studied immunohistochemically for the expression of beta-human chorionic gonadotrophin (beta-HCG). Only 5 Ta-T1 tumours contained a small number of beta-HCG positive cells but 24 invasive tumours and all patients with metastases showed increased numbers of positive cells. A significant correlation was found between beta-HCG immunoreactivity and tumour category. In 30 patients with muscle-invasive disease (T2-T4,N0,M0) who were treated with radical radiotherapy a significant correlation was observed between response to treatment and beta-HCG expression; beta-HCG positive tumours did not respond to treatment. A difference in survival was found between patients with tumours negative for beta-HCG compared with patients with positive tumours, all treated with radical radiotherapy. The results indicate that beta-HCG expression increases with tumour invasiveness and the use of immunohistochemistry may prove a useful means of identifying radioresistant and aggressive forms of bladder cancer.

Neuroendocrine differentiation in carcinoma of the prostate. Diagnostic, prognostic, and therapeutic implications

Endocrine-paracrine cells of the prostate (also known as APUD or neuroendocrine cells) constitute, in addition to the basal and exocrine secretory cells, a third population of highly specialized epithelial cells in the prostate gland. These endocrine-paracrine cells contain, and most likely secrete, serotonin and calcitonin, as well as variety of other peptides. Little is known of the functional role of these cells, but they probably subserve a paracrine or local regulatory role. They may also regulate via endocrine, lumencrine, or neurocrine mechanisms. These endocrine-paracrine cells probably play a significant role during prostatic growth and differentiation as well as regulating the secretory process of the mature gland. Neuroendocrine differentiation in prostatic carcinoma occurs in the form of the relatively rare small cell carcinoma and carcinoid or carcinoid-like tumor, but most commonly as focal neuroendocrine differentiation in a conventional prostatic adenocarcinoma that is a very frequent, if not ubiquitous phenomenon, and reflects tumor cell heterogeneity mimicking the normal differentiation process. The world's literature on neuroendocrine differentiation in prostatic carcinoma is reviewed. Neuroendocrine differentiation in all types of prostatic carcinoma appears to correlate with a poor prognosis. This correlation is probably multifactorial and may relate to a positive correlation with grade, a direct resistance to hormonal manipulation, and/or autocrine/paracrine growth factor activity due to the secretion of neuroendocrine products. Neuron-specific enolase and chromogranin, as well as other neuroendocrine products, may be useful as serum markers in patients with prostatic carcinoma with neuroendocrine differentiation. New therapeutic strategies need to be developed to treat these tumors. This includes the use of specialized protocols that have been effective against neuroendocrine carcinomas arising in other organ systems.

Serum and urinary levels of beta human chorionic gonadotrophin in patients with transitional cell carcinoma

Serum and early morning urine specimens were obtained from 62 patients. The levels of beta human chorionic gonadotrophin (BhCG) in both serum and urine were estimated simultaneously in all cases. At the time of estimation 43 patients had transitional cell carcinoma of the bladder, one had transitional cell carcinoma of the renal pelvis and three had carcinoma in situ (two of whom also had overt carcinoma). Raised serum and urinary levels were found in only three patients, all of whom had poorly differentiated or metastatic transitional cell carcinoma of the bladder. This observation is in accordance with previous studies. In one of these patients, who underwent transurethral resection of her bladder tumour, the urinary levels returned to within normal limits post resection. An additional three patients had elevations of serum BhCG. Two of these three patients had poorly differentiated transitional cell carcinoma present at the time of estimation and one had no sign of recurrence. Using immunoperoxidase staining a retrospective study was undertaken to stain all available sections belonging to patients studied to observe whether BhCG was being produced by the respective tumours. Twelve well differentiated, nine moderately well differentiated and seven poorly differentiated specimens were available. In no case was evidence of BhCG production demonstrated in these tumours despite its presence being demonstrable in positive controls. We confirm the production of BhCG associated with bladder tumours, a feature correlated with poorer differentiation. Studies employing larger patient numbers are necessary to clarify the role of this tumor marker in patients with well differentiated bladder tumours.

Human chorionic gonadotropin, neuron specific enolase and deoxyribonucleic acid flow cytometry in patients with high grade bladder carcinoma

Biopsies from 64 patients with transitional cell carcinoma of the bladder (World Health Organization grade 3 and undifferentiated) were studied with deoxyribonucleic acid flow cytometry of fresh tissue and immunohistochemical staining on the histopathological slides for the presence of neuron specific enolase and human chorionic gonadotropin. No correlation was found among the presence of neuron specific enolase or human chorionic gonadotropin and T category, deoxyribonucleic acid ploidy, percentage of cells in the S phase, presence of metastatic disease or response to therapy. The prognosis for patients with muscle invasive disease and tumors positive for neuron specific enolase or human chorionic gonadotropin was similar to that for patients with tumors negative for these substances. When a possible new marker or prognostic factor is evaluated, it is important to investigate whether the new marker adds information on prognosis to what already is known by established standard methods. Further studies are needed to evaluate the clinical importance of human chorionic gonadotropin (and neuron specific enolase) as a marker in urothelial cancer with regard to prognosis and response to therapy.

Beta human chorionic gonadotrophin in serum and urine. A marker for metastatic urothelial cancer

Beta human chorionic gonadotrophin (beta HCG) was measured in 127 urine and 85 serum samples from 175 untreated patients with urothelial cancer. Serum levels of beta HCG were substantially elevated in 16 of 21 patients (76%) with widespread metastases but in only 2 of 64 patients (3%) with disease confined to the pelvis. Urine beta HCG levels were moderately raised in 11 of 25 patients (44%) with locally advanced disease, but greatly elevated in 5 of 7 patients (71%) with metastases. Measurement of serum and/or urine beta HCG appears to be an efficient diagnostic marker for the presence of distant metastases in bladder carcinoma.

Placental proteins in high-grade urothelial neoplasms. An immunohistochemical study of human chorionic gonadotropin, human placental lactogen, and pregnancy-specific beta-1-glycoprotein

We examined the presence of human chorionic gonadotropin (HCG) in 16 low-grade and 47 high-grade urothelial neoplasms, including two cases with trophoblastic-like differentiation. In HCG-positive tumors, the presence of human placental lactogen (HPL) and pregnancy-specific beta-1-glycoprotein (SP-1) also was assessed. HCG immunoreactive cells were found in nine of the 47 high-grade tumors (19%), whereas none of the low-grade tumors were positive for HCG. This hormone was predominantly detected in the most undifferentiated and pleomorphic areas; however, HCG-positive cells also were found in areas of carcinoma in situ and well-differentiated transitional cell carcinoma in two cases. The serum HCG level was increased in two of the four cases studied. HPL and SP-1 immunoreactive cells were observed in seven and five cases, respectively, and it was found that tumors positive for SP-1 also were positive for HPL. Five tumors, including the two with trophoblastic differentiation, contained the three placental proteins. The HPL and SP-1 immunostained cells were usually found in the same areas of the tumor that were positive for HCG, but there was always a lower number of HPL and SP-1 immunoreactive cells than HCG immunoreactive cells. In one case, HPL and SP-1 could be found in areas of well-differentiated transitional cell carcinoma. These findings suggest that the morphologic and functional trophoblastic differentiation in urothelial carcinomas is a progressive phenomenon evolving from transitional cell carcinomas.

Choriocarcinoma arising in transitional cell carcinoma of bladder: a case report

Trophoblastic metaplasia can occasionally occur in transitional cell carcinomas of the bladder and the resultant choriocarcinoma is likely to behave differently from typical epithelial bladder tumours.

Ectopic production of human chorionic gonadotropin by poorly differentiated transitional cell tumors of the urinary tract

We performed a 5-year histopathological review of 41 consecutive cases of transitional cell carcinoma. Of these cases 8 were positive for human chorionic gonadotropin immunoperoxidase tissue staining. All tumors were grade III and stages ranged from A to D. Three patients presented with gynecomastia as the clinical manifestation of elevated serum levels of beta-human chorionic gonadotropin. These findings document the association of this phenomenon with lesions of an aggressive nature. As with the loss of cell surface antigens, the appearance of human chorionic gonadotropin within the tumor cells may be further evidence of dedifferentiation. Human chorionic gonadotropin production may be a potential marker to gauge tumor response to chemotherapy and, perhaps, a predictor of future aggressiveness and over-all progression.

Trophoblastic metaplasia in urothelial carcinoma of the bladder

Trophoblastic differentiation in bladder carcinoma is reported in four patients. Plasma gonadotrophin (beta subunit of HCG), measured in three patients, was elevated. In one patient treated with cisplatin, vinblastine and bleomycin, the beta HCG level fell significantly but progression of malignant disease was not arrested.