title: Ectopic production and localization of beta-human chorionic gonadotropin in lymphoepithelioma-like carcinoma of the cervix: a case report.
abstract: A 32-year-old woman underwent a suction curettage for missed abortion. The initial serum human chorionic gonadotropin (beta-hCG) level was 40 IU/ml. The histologic examination of the uterine curettage specimen showed scant strips of a poorly differentiated malignant neoplasm and no chorionic villi. The tumor showed strong immunoreactivity for cytokeratin (AE1/AE3) and beta-hCG but no reactivity for human placental lactogen. The combination of histologic appearance, beta-hCG immunoreactivity, and elevation of serum beta-hCG raised a strong suspicion for epithelioid trophoblastic tumor (ETT). Postcurettage serial serum beta-hCG levels remained in the range of 20 to 45 micrograms/ml. Computerized tomographic scan showed a 1.0-cm circumscribed mass in the upper endocervix. A radical hysterectomy and pelvic lymphadenectomy were performed. Gross examination of the hysterectomy specimen likewise showed a well-circumscribed mass in the upper endocervix. Histologic examination revealed an undifferentiated carcinoma accompanied by intense lymphoplasmacytic infiltrate. A final diagnosis of lymphoepithelioma-like carcinoma (LELC) was rendered. LELC with elevated serum beta-hCG level and immunoreactivity to beta-hCG should be distinguished from ETT in a small endocervical curettage sample.
authors.affiliation: Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9073, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Coleman
authors.forename: G
authors.initials: G
authors.lastname: Lindberg
authors.forename: C Y
authors.initials: CY
authors.lastname: Muller
authors.forename: D S
authors.initials: DS
authors.lastname: Miller
authors.forename: A
authors.initials: A
authors.lastname: Hameed
mesh_terms: D000030:Abortion, Missed; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000737:chemistry* / Q000175:diagnosis / Q000473:pathology; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000032:analysis* / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007633:Keratins / Q000032:analysis; D008214:Lymphocytes / Q000473:pathology*; D009336:Necrosis; D010928:Placental Lactogen / Q000032:analysis; D010950:Plasma Cells / Q000473:pathology*; D011247:Pregnancy; D014328:Trophoblastic Neoplasms; D002583:Uterine Cervical Neoplasms / Q000737:chemistry* / Q000175:diagnosis / Q000473:pathology
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D007633:Keratins; D010928:Placental Lactogen