Abstract
We describe a case of hCG-producing large cell carcinoma of the lung in a 73-year-old man who had gynecomastia associated with high serum concentration of hCG. Serum hCG levels fluctuated in parallel with the response of the cancer to surgery, chemotherapy, and radiotherapy.
The patient was admitted to our hospital with a huge mass shadow in the right lung filed on chest X-ray film on July 31, 1989. Physical examination revealed bilateral gynecomastia. Serum hCG and beta-hCG were 1108.0mIU/ml (Normal<2.0) and 31.9ng/ml (Normal<1.0), respectively. Clinical staging was T2N1M0, determined by radioisotope scanning of bone, and CT scans of the chest, brain, and upper abdomen. Right upper and middle lobectomy with mediastinal lymph node dissection was performed on August 18, 1989. The tumor, 6×6×8cm in size, was located in the middle lobe and was histologically comfirmed to be large cell carcinoma of the lung. A few of small nodules found on the surface of the middle lobe at thoracotomy were histologically proved to be pleural dissemination. Metastatic involvement was present in the hilar and mediastinal lymph nodes. The pathological stage was concluded to be T4N2M0. Immunohistochemistry showed positive staining reaction for hCG within some of the tumor cells. Three weeks after the operation, serum hCG had decreased rapidly but did not reach the normal range. Two courses of CDDP, VDS, and MMC were given at four week intervals. Following chemotherapy, serum hCG decreased to the normal range. He was discharged from our hospital on November 29, 1989. Serum hCG remained within normal limits during follow-up at our outpatient clinic. On February 14, 1990, serum hCG and beta-hCG increased to 105.0mIU/ml and 1.8ng/ml, respectively. On February 20, he was readmitted because of nausea and weakness. A CT scan of the brain revealed multiple space-occupying lesions suggesting metastasis. Radioistope bone scanning and CT scans of the chest and upper abdomen showed no abnormalities. Whole brain irradiation (40Gy) was performed from February 26 to March 29. Serum hCG decreased temporarily but soon increased. He died on June 26, 1990.
Serum hCG levels appear to be a useful parameter for the evaluation of treatment and the prediction of prognosis.
