Ovarian choriocarcinoma: a difficult diagnosis of an unusual tumor and a review of the hook effect.
Ovarian choriocarcinoma is difficult to diagnose in the reproductive-age patient. A case of nongestational ovarian choriocarcinoma is discussed which presented like a molar pregnancy initially. Because of falsely low beta-hCG values (283 mIU/L) caused by the high-dose "hook effect" in the double antibody immunoassay system, however, a diagnosis of ectopic pregnancy was entertained. At laparotomy, a large necrotic ovarian choriocarcinoma was found along with large theca lutein cysts. The hook effect may mislead the clinician, and it is important to recognize this effect to avoid misdiagnosis.
Department of Obstetrics and Gynecology, Tulane University School of Medicine, New Orleans, Louisiana.
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CA
Wheeler
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S
Davis
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S
Degefu
I H
IH
Thorneycroft
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AG
O'Quinn
D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D002822:Choriocarcinoma / Q000175:diagnosis* / Q000473:pathology; D006063:Chorionic Gonadotropin / Q000097:blood*; D018997:Chorionic Gonadotropin, beta Subunit, Human; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology; D010446:Peptide Fragments / Q000097:blood*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis; D011863:Radioimmunoassay
D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments