title: Extragestational βHCG secretion due to an isolated lung epithelioid trophoblastic tumor: microsatellite genotyping of tumoral cells confirmed their placental origin and oriented specific chemotherapy.
abstract: BACKGROUND
  Persistent secretion of β-human chorionic gonadotropin (βHCG) in the absence of an ongoing or recent pregnancy and without persistent uterine gestational disease is a rare but challenging situation that requires locating the extrauterine secreting tumor and distinguishing between extragestational choriocarcinoma and gestational trophoblastic neoplasms.
  
  
  METHODS
  An unexplained, persistent extragestational βHCG secretion occurring in a 29-year-old, nonsmoking woman with abnormal uterine bleeding 4 years after a normal pregnancy and without persistent gestational disease led to the discovery by whole-body computed tomography/positron emission tomography of an isolated pulmonary tumor.
  
  
  OBJECTIVE
  Characterization of paternal alleles in tumoral cells in order to establish their fetal origin, which may be helpful for the diagnosis and treatment of such tumors.
  
  
  RESULTS
  After the surgical procedure, clinical, histological, and immunocytochemical analysis ruled out primary or metastatic bronchopulmonary carcinoma or choriocarcinoma and supported the diagnosis of an isolated, primary, epithelioid trophoblastic tumor. Microsatellite genotyping of tumoral cells identifying paternal alleles confirmed their placental origin and their migration to the lungs, with likely secondary malignant transformation, and guided the choice of postsurgical chemotherapy needed to completely eradicate βHCG secretion.
  
  
  CONCLUSIONS
  Persistent extragestational secretion of βHCG in a young nonsmoking woman with a precedent pregnancy and an isolated lung tumor suggests the diagnosis of epithelioid trophoblastic tumor, a very rare malignant tumor for which placental origin needs to be confirmed, especially when occurring several years after the patient's last pregnancy. Simple microsatellite genotyping of tumoral cells will allow this confirmation of diagnosis and help in personalizing chemotherapy.
authors.affiliation: Department of Reproductive Endocrinology (P.F., A.-G.P.), University Hospital of Nice, 06200 Nice, France; Inserm U1065 C3M (P.F.), University of Nice Sophia-Antipolis, 06202 Nice, France; Laboratory of Medical Genetics and Molecular Biology (C.R.), Laboratory of Clinical and Experimental Pathology (C.B.), and Department of Medical Imaging (P.C.), Centre Hospitalier Universitaire (CHU) de Nice, 06202 Nice, France; Department of Medical Oncology (A.T.), Centre Antoine Lacassagne, 06100 Nice, France; and Department of Thoracic Surgery (J.M.), CHU Nice, 06002 Nice, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Fénichel
authors.forename: Cécile
authors.initials: C
authors.lastname: Rouzier
authors.forename: Catherine
authors.initials: C
authors.lastname: Butori
authors.forename: Patrick
authors.initials: P
authors.lastname: Chevallier
authors.forename: Anne-Gaelle
authors.initials: AG
authors.lastname: Poullot
authors.forename: Antoine
authors.initials: A
authors.lastname: Thyss
authors.forename: Jérôme
authors.initials: J
authors.lastname: Mouroux
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood / Q000378:metabolism*; D003937:Diagnosis, Differential; D015622:Epithelioid Cells / Q000378:metabolism / Q000473:pathology; D005260:Female; D005820:Genetic Testing; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000556:secondary; D018895:Microsatellite Repeats; D011247:Pregnancy; D018245:Trophoblastic Tumor, Placental Site / Q000188:drug therapy / Q000235:genetics / Q000556:secondary; D014327:Trophoblasts / Q000378:metabolism / Q000473:pathology
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human