title: A case of a Beta-human chorionic gonadotropin secreting sinonasal teratocarcinosarcoma.
abstract: Background and Importance Sinonasal teratocarcinosarcoma (SNTCS) is an unusual and aggressive neoplasm characterized by the combination of teratoma and carcinosarcoma features that is often misdiagnosed based on a biopsy sample. Approximately 60 cases have been reported in the English literature, but none have been associated with serum tumor markers. We report a case of SNTCS with elevation of serum β-human chorionic gonadotropin (hCG) level. Clinical Presentation The patient was a 22-year-old pregnant woman at diagnosis, and her β-hCG level was appropriately elevated. Her initial treatment was a surgical resection followed by radiation therapy (RT). Two years later, the patient had a pregnancy work-up after a sexual assault. Her serum β-hCG was elevated, but a nongravid uterus was seen on ultrasound. Magnetic resonance imaging (MRI) of the head revealed an intracranial tumor recurrence in the right frontal lobe. During salvage RT, β-hCG decreased rapidly to normal levels, with a complete tumor response on MRI. Retrospective examination of the initial surgical specimen showed expression of β-hCG associated with the anaplastic mesenchymal component. Conclusion This is the first reported case of a β-hCG secreting SNTCS. The source of β-hCG production was traced to a neoplastic smooth muscle component of the tumor.
authors.affiliation: Department of Radiation Oncology, Wayne State University, Detroit, Michigan, United States.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Weinberg
authors.affiliation: Department of Pathology, University of Kansas Medical Center, Kansas City, Kansas, United States.
authors.forename: Kathy L
authors.initials: KL
authors.lastname: Newell
authors.affiliation: Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, United States.
authors.forename: Fen
authors.initials: F
authors.lastname: Wang
keywords: gonadotropin; intracranial; serum; teratocarcinosarcoma; β-hCG
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