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An unusual cause of gynaecomastia in a male

Beta-human chorionic gonadotropin (βhCG) is normally produced by syncytiotrophoblasts of the placenta during pregnancy and aids embryo implantation. However, it is also secreted in varying amounts in non-pregnant conditions commonly heralding a neoplastic process. We present a case of 50-year-old ma...

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Autores principales: Rehman, Tejhmal, Hameed, Ali, Beharry, Nigel, Parcq, J Du, Bano, Gul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612059/
https://www.ncbi.nlm.nih.gov/pubmed/31373476
http://dx.doi.org/10.1530/EDM-19-0060
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author Rehman, Tejhmal
Hameed, Ali
Beharry, Nigel
Parcq, J Du
Bano, Gul
author_facet Rehman, Tejhmal
Hameed, Ali
Beharry, Nigel
Parcq, J Du
Bano, Gul
author_sort Rehman, Tejhmal
collection PubMed
description Beta-human chorionic gonadotropin (βhCG) is normally produced by syncytiotrophoblasts of the placenta during pregnancy and aids embryo implantation. However, it is also secreted in varying amounts in non-pregnant conditions commonly heralding a neoplastic process. We present a case of 50-year-old man, who presented with bilateral gynaecomastia with elevated testosterone, oestradiol, suppressed gonadotropins with progressively increasing levels of human chorionic gonadotropin (hCG). Biochemical and radiological investigations including ultrasonography of testes, breast tissue, MRI pituitary and CT scan full body did not identify the source of hCG. FDG PET scan revealed a large mediastinal mass with lung metastasis. Immunostaining and histological analysis confirmed the diagnosis of primary choriocarcinoma of the mediastinum. It is highly aggressive and malignant tumor with poor prognosis. Early diagnosis and management are essential for the best outcome. LEARNING POINTS: High βhCG in a male patient or a non-pregnant female suggests a paraneoplastic syndrome. In the case of persistently positive serum hCG, exclude immunoassay interference by doing the urine hCG as heterophilic antibodies are not present in the urine. Non-gestational choriocarcinoma is an extremely rare trophoblastic tumor and should be considered in young men presenting with gynaecomastia and high concentration of hCG with normal gonads. A high index of suspicion and extensive investigations are required to establish an early diagnosis of extra-gonadal choriocarcinoma. Early diagnosis is crucial to formulate optimal management strategy and to minimize widespread metastasis for best clinical outcome.
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spelling pubmed-66120592019-07-09 An unusual cause of gynaecomastia in a male Rehman, Tejhmal Hameed, Ali Beharry, Nigel Parcq, J Du Bano, Gul Endocrinol Diabetes Metab Case Rep Unique/Unexpected Symptoms or Presentations of a Disease Beta-human chorionic gonadotropin (βhCG) is normally produced by syncytiotrophoblasts of the placenta during pregnancy and aids embryo implantation. However, it is also secreted in varying amounts in non-pregnant conditions commonly heralding a neoplastic process. We present a case of 50-year-old man, who presented with bilateral gynaecomastia with elevated testosterone, oestradiol, suppressed gonadotropins with progressively increasing levels of human chorionic gonadotropin (hCG). Biochemical and radiological investigations including ultrasonography of testes, breast tissue, MRI pituitary and CT scan full body did not identify the source of hCG. FDG PET scan revealed a large mediastinal mass with lung metastasis. Immunostaining and histological analysis confirmed the diagnosis of primary choriocarcinoma of the mediastinum. It is highly aggressive and malignant tumor with poor prognosis. Early diagnosis and management are essential for the best outcome. LEARNING POINTS: High βhCG in a male patient or a non-pregnant female suggests a paraneoplastic syndrome. In the case of persistently positive serum hCG, exclude immunoassay interference by doing the urine hCG as heterophilic antibodies are not present in the urine. Non-gestational choriocarcinoma is an extremely rare trophoblastic tumor and should be considered in young men presenting with gynaecomastia and high concentration of hCG with normal gonads. A high index of suspicion and extensive investigations are required to establish an early diagnosis of extra-gonadal choriocarcinoma. Early diagnosis is crucial to formulate optimal management strategy and to minimize widespread metastasis for best clinical outcome. Bioscientifica Ltd 2019-07-03 /pmc/articles/PMC6612059/ /pubmed/31373476 http://dx.doi.org/10.1530/EDM-19-0060 Text en © 2019 The authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (http://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Unique/Unexpected Symptoms or Presentations of a Disease
Rehman, Tejhmal
Hameed, Ali
Beharry, Nigel
Parcq, J Du
Bano, Gul
An unusual cause of gynaecomastia in a male
title An unusual cause of gynaecomastia in a male
title_full An unusual cause of gynaecomastia in a male
title_fullStr An unusual cause of gynaecomastia in a male
title_full_unstemmed An unusual cause of gynaecomastia in a male
title_short An unusual cause of gynaecomastia in a male
title_sort unusual cause of gynaecomastia in a male
topic Unique/Unexpected Symptoms or Presentations of a Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612059/
https://www.ncbi.nlm.nih.gov/pubmed/31373476
http://dx.doi.org/10.1530/EDM-19-0060
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