title: Beta-human chorionic gonadotropin production associated with phyllodes tumor of the breast: an unusual paraneoplastic phenomenon.
abstract: Phyllodes tumors (PTs) of the breast are uncommon and account for < 1% of all breast tumors. Most patients present with mass lesions; however, there are rare reports of patients presenting with paraneoplastic conditions such as hypoglycemia secondary to insulin-like growth factor II secretion. A 55-year-old woman presented with a rapidly enlarging left breast mass which ulcerated through the skin and invaded the underlying muscle. The serum beta-human chorionic gonadotropin (beta-hCG) level was found to be 58 mIU/mL preoperatively; this dropped to 2 mIU/mL after surgery. Mastectomy showed a 14.5-cm fibroepithelial neoplasm, the majority of which was composed of a cellular spindle/epithelioid-cell proliferation with the focal presence of elongated epithelial clefts consistent with a PT. In addition to the presence of unequivocal sarcomatous stromal overgrowth and prominent mitotic activity, there were areas of lace-like osteoid production by tumor cells, and a diagnosis of malignant PT with osteosarcomatous foci was rendered. Immunohistochemical studies showed focal beta-hCG expression within the epithelioid stroma of the tumor; expression of p63 and cytokeratin was only seen in the epithelial component and there was no expression of placental alkaline phosphatase in either component. Although beta-hCG expression/production has been described in many nontrophoblastic tumors (mostly carcinomas of various organs), to our knowledge this is the first case documenting this in a PT of the breast. Whether this intriguing finding represents an isolated association or has more significant implications remains to be determined.
authors.affiliation: Department of Pathology, University of Alabama School of Medicine, Birmingham, Alabama 35294-6823, USA.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Reisenbichler
authors.forename: Helen
authors.initials: H
authors.lastname: Krontiras
authors.forename: Omar
authors.initials: O
authors.lastname: Hameed
mesh_terms: D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000032:analysis*; D005260:Female; D017228:Hepatocyte Growth Factor / Q000032:analysis*; D006801:Humans; D007150:Immunohistochemistry; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D009336:Necrosis; D009361:Neoplasm Invasiveness; D012516:Osteosarcoma / Q000473:pathology; D003557:Phyllodes Tumor / Q000473:pathology* / Q000601:surgery; D012883:Skin Ulcer / Q000209:etiology / Q000473:pathology
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; C066855:HGF protein, human; D017228:Hepatocyte Growth Factor