The chemotherapy of metastatic gastric adenocarcinomas with hypersecretion of alpha-fetoprotein or beta-human chorionic gonadotrophin: report of two cases

An Immaculate Deception: Persistently Elevated Serum β-Hcg in Metastatic Signet Ring Cell Gastric Adenocarcinoma

BACKGROUND

Persistent elevations in beta-human chorionic gonadotropin (β-hCG) can be an ominous sign of both trophoblastic and non-trophoblastic malignancies. The absence of a clearly identified etiology of β-hCG elevation warrants pursuit of further diagnostic testing to determine the source of ectopic β-hCG.

CASE REPORT

A virginal 26-year-old woman with past medical history significant for persistently elevated β-hCG presented to our Emergency Department with shortness of breath, pleuritic chest pain, nausea, and vomiting, and was found to have widely metastatic gastric signet ring cell adenocarcinoma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although elevated serum β-hCG is a generally a marker of pregnancy, β-hCG elevation without clear etiology necessitates ruling out other insidious processes. Failure to maintain and pursue a broad differential in the context of unexplained elevations of β-hCG can result in catastrophic missed or delayed diagnosis.

MCM3AP-AS1: An Indispensable Cancer-Related LncRNA

Long non-coding RNAs (lncRNAs) are a class of RNA molecules with transcripts longer than 200 nucleotides that have no protein-coding ability. MCM3AP-AS1, a novel lncRNA, is aberrantly expressed in human cancers. It is significantly associated with many clinical characteristics, such as tumor size, tumor-node-metastasis (TNM) stage, and pathological grade. Additionally, it considerably promotes or suppresses tumor progression by controlling the biological functions of cells. MCM3AP-AS1 is a promising biomarker for cancer diagnosis, prognosis evaluation, and treatment. In this review, we briefly summarized the published studies on the expression, biological function, and regulatory mechanisms of MCM3AP-AS1. We also discussed the clinical applications of MCM3AP-AS1 as a biomarker.

Hepatoid Adenocarcinoma Presenting as Pancreatitis

Hepatoid adenocarcinoma (HAC) is an uncommon and aggressive type of adenocarcinoma, typically affecting the middle-aged and elderly. The morphological features of the HAC resemble hepatocellular carcinoma. Presenting symptoms may include upper abdominal pain, hematemesis, back pain, and palpable abdominal mass. HAC has no proven therapy, and the prognosis is extremely poor. Early surgical removal with chemotherapy remains the standard of care. We describe one of the youngest patients in the literature with HAC who presented with acute pancreatitis. The diagnostic workup was confused by diffuse lymphadenopathy and elevated β-human chorionic gonadotropin making lymphoma and germ cell tumor likely possibilities until immunohistochemistry confirmed the diagnosis.

A Case of a False-Positive Urine Pregnancy Test and Delayed Diagnosis of Obstructive Pyelonephritis

Patient: Female, 28-year-old

Final Diagnosis: Obstructive pyelonephritis

Symptoms: Dysuria • epigastric pain • flank pain

Medication: —

Clinical Procedure: —

Specialty: General and Internal Medicine

A non-pregnant woman with elevated beta-HCG: A case of para-neoplastic syndrome in ovarian cancer

There is a broad range of possible diagnoses for an elevated beta human chorionic gonadotropin (β-hCG) in the absence of intrauterine or ectopic pregnancy. When women of child bearing potential undergo evaluation for clinical trial, it is often unclear what course of evaluation to take when a pregnancy test is positive. We describe the clinical course of a patient with widely metastatic mucinous ovarian carcinoma with metastasis to the peritoneum, lymph nodes and liver. The patient was found to have a mildly elevated β-hCG during initial evaluation for clinical trial. Extensive work up for ectopic pregnancy, trophoblastic disease, and phantom β-hCG were negative. The patient's β-hCG levels continued to rise until initiation of therapy. She was treated on a phase I protocol with restaging scans revealing a partial response. The β-hCG was retested and declined in conjunction with her response, consistent with paraneoplastic β-hCG. Here, we propose a decision making algorithm to evaluate a patient with an elevated β-hCG undergoing assessment for clinical trial.

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Evaluation of positive pregnancy test during clinical trial accrual is difficult.

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We describe a case of a woman with metastatic ovarian cancer.

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The patient was found to have an elevated β-hCG during clinical trial evaluation.

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We propose a decision making algorithm to evaluate these patients.

Krukenberg tumor presenting as back pain and a positive urine pregnancy test: a case report and literature review

A Krukenberg tumor is a rare and potentially deadly cause of elevated serum β-hCG as part of a paraneoplastic syndrome. This study aims to describe the unusual case of a 36-year-old woman that presented to the Emergency Department (ED) with back pain and a positive urine pregnancy test. Assessment revealed no intrauterine pregnancy and a small left ovarian cyst. Further investigation showed moderately differentiated gastric adenocarcinoma with distant metastases to the spine. The patient died less than 3 months after her first presentation to the ED. Paraneoplastic syndrome, albeit rare, should be considered in the differential diagnosis of elevated β-hCG due to the high mortality associated with Krukenberg tumors.

False-positive human serum chorionic gonadotropin in a patient with a history of germ cell cancer

Tumor markers, including the beta-subunit of human chorionic gonadotropin (beta-hCG), and radiological imaging methods are commonly used for the diagnosis and monitoring of testicular cancer. We report of a patient with a history of classical seminoma stage I who had elevated serum levels of beta-hCG suggesting relapse 5 years after initial treatment. Radiological evaluation revealed a pericardial cyst, which was surgically removed. Histological evaluation did not demonstrate malignant tissue, suggesting a false-positive beta-hCG. Further workup confirmed this suspicion as we could demonstrate false-positive test results due to heterophilic antibodies detectable in the patient's serum. This case stresses the need for verification of beta-hCG levels in patients where clinical results are not in line with laboratory results.