title: High level of beta-hCG simulating pregnancy in recurrent osteosarcoma: case report and review of literature.
abstract: OBJECTIVE
  A high serum level of beta human chorionic gonadotropin (hCG) normally indicates pregnancy in healthy women. We were confused by this finding in one of our patients. This 18-year-old girl presented with amenorrhoea of 1-month duration, a positive pregnancy test and a high beta-hCG serum level although taking contraceptives. Pregnancy was excluded by ultrasound. Three years previously, she had had an osteosarcoma of the humerus. The tumour initially had been wide resected and had shown a good response to neoadjuvant chemotherapy with COSS-96-protocol.
  
  
  METHODS
  We reviewed the original histological result and the literature about possible similar findings. We analysed therapeutic options and the value of beta-hCG levels as a therapy monitor.
  
  
  RESULTS
  During examination we detected a recurrent osteosarcoma of the left humerus. The local relapse evidently expressed beta-hCG which, retrospectively, could only sparsely be shown in the primary resectate. After intralesional surgery, chemotherapy and radiotherapy levels of beta-hCG normalised.
  
  
  CONCLUSIONS
  Osteosarcoma very rarely is able to produce a paraneoplastic syndrome by high levels of beta-hCG. This may well be of diagnostic value and offer an additional monitoring tool. It can indicate tumour recurrence and dedifferentiation.
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany. leidinb@uni-muenster.de
authors.forename: B
authors.initials: B
authors.lastname: Leidinger
authors.forename: S
authors.initials: S
authors.lastname: Bielack
authors.forename: G
authors.initials: G
authors.lastname: Koehler
authors.forename: V
authors.initials: V
authors.lastname: Vieth
authors.forename: W
authors.initials: W
authors.lastname: Winkelmann
authors.forename: G
authors.initials: G
authors.lastname: Gosheger
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D001859:Bone Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006811:Humerus / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D012516:Osteosarcoma / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D010257:Paraneoplastic Syndromes / Q000097:blood / Q000175:diagnosis; D011247:Pregnancy; D011258:Pregnancy Tests; D018714:Radiotherapy, Adjuvant
chemical_list: D014408:Biomarkers, Tumor; D018997:Chorionic Gonadotropin, beta Subunit, Human