The re-awakening of hCG expression. Its role in the diagnosis of cervical squamous cell carcinoma

Human chorionic gonadotropin expression in endometrial hyperplasia and endometrial carcinoma: could it be a new marker?

Objective

Human chorionic gonadotropin (hCG) is a glycoprotein hormone expressed in a variety of tumors and is correlated with advanced stage disease and poor prognosis. This study aimed to determine hCG expression immunohistochemically in endometrial specimens obtained from patients with normal endometrium, endometrial hyperplasia, and endometrial carcinoma, and to determine if there is a correlation between invasiveness and hCG positivity.

Methods

The histologic materials and medical records for patients diagnosed with normal endometrium, endometrial hyperplasia with/without atypia, and endometrial carcinoma between September 2017 and September 2020 were retrospectively reviewed. Immunohistochemical staining for hCG was performed and analyzed semi-quantitatively.

Results

A total of 96 patients were included: normal endometrium (27.1%) (n=26); endometrial hyperplasia without atypia (25%) (n=24); atypical endometrial hyperplasia (22.9%) (n=22); endometrioid endometrial cancer (25%) (n=24). Median age of the patients was 48 (range 28–81) years. hCG was positive in 8.3% of patients with endometrial hyperplasia without atypia, 18.2% in those with atypical endometrial hyperplasia, and 41.7% in those with endometrial cancer (p<0.001). None of the patients with normal endometrium had a positive hCG. The rate of endometrial cancer was 62.5% in the hCG-positive group and 17.5% in the hCG-negative group.

Conclusion

hCG is expressed to a significantly greater degree in patients with atypical endometrial hyperplasia and endometrial carcinoma and it may be potentially used as a marker for these lesions.

Lung neoplasm mimicking as ectopic pregnancy due to paraneoplastic secretion of human chorionic gonadotropin: a case report and literature review

PURPOSE

The present systematic review aimed to examine the relationship between lung neoplasm and human chorionic gonadotropin (HCG). Especially, women with lung neoplasm mimicking as ectopic pregnancy were explored.

METHODS

A rare case of lung neoplasm with high serum β-HCG, which was initially thought to be ectopic pregnancy, was reported. A literature search was performed of the US National Library of Medicine (MEDLINE), EMBASE, PubMed, and the Cochrane Database of Systematic Reviews using appropriate keywords and subject headings to February 2020.

RESULTS

Studies assessed lung neoplasm patients with positive HCG were included. Twenty studies, including 24 patients, were included. These cases illustrate the importance of considering the possibility of paraneoplastic secretion of β-HCG in patients who have a positive pregnancy test. This may prevent a delay in the diagnosis and treatment of malignancy in young women. Of the 24 cases, only 7 (29.17%) were managed surgically; others were managed conservatively or with chemotherapy or radiation.

CONCLUSION

The present systematic review shows the need to re-awaken awareness and high index of suspicion to lung neoplasm diagnosis in patients with positive pregnancy test.

Persistently elevated hCG in a patient with no clear evidence of pregnancy

BACKGROUND

We describe a case of a female patient with a complex medical history, including squamous cell carcinoma of the tongue, and persistent elevation in serum hCG and no confirmed intrauterine or extrauterine pregnancy.

METHODS

The clinical chemistry laboratory was called upon to help clarify the situation and reach a diagnosis.

RESULTS

Multiple potential sources of elevated hCG were considered and excluded.

CONCLUSIONS

This case shows a rare example of paraneoplastic hCG expression and highlights the role of the clinical chemistry laboratory in resolving diagnostic dilemmas and interpreting laboratory results in patients with multiple medical comorbidities.