Persistently elevated β-human chorionic gonadotropin level after vacuum-assisted uterine aspiration: a case report

BACKGROUND: Urothelial carcinoma of the bladder accounts for nearly 90% of all bladder cancers. Risk factors include cigarette smoke, chronic cystitis, and human papilloma virus infection. It is commonly diagnosed by hematuria, obstructive voiding, and irritative symptoms. Despite the prevalence of urothelial carcinoma, elevation of β-human chorionic gonadotropin in the setting of these malignancies is not common. This case report informs gynecologic practitioners to consider urologic causes of β-human chorionic gonadotropin elevation even in the setting of recent spontaneous abortion and details comprehensive review of diagnostic testing in the setting of β-human chorionic gonadotropin elevation. CASE PRESENTATION: A 49-year-old, non-Hispanic Caucasian woman, former smoker, with a history of polycystic ovary syndrome, high-risk human chorionic gonadotropin infection, and hypertension, underwent vacuum-assisted aspiration for significant vaginal bleeding in the setting of incomplete abortion. Fetal tissue was confirmed pathologically. Human chorionic gonadotropin levels decreased to 12.5 mU/mL and were no longer followed due to resumption of menses. Five months later during routine preoperative evaluation for orthopedic surgery, her human chorionic gonadotropin level was found to be elevated. She was also noted to have persistent asymptomatic hematuria. She completed an extensive gynecologic and urologic work-up, including hysteroscopy, dilation and curettage, methotrexate therapy, computerized tomographic imaging, and cystoscopy to finally arrive at the diagnosis of urothelial carcinoma. CONCLUSIONS: Only a rare subset of urothelial carcinomas secretes β-human chorionic gonadotropin. Therefore, diagnosis of urothelial carcinoma is typically achieved by urine cytology with cystoscopic biopsy. Although rare, urothelial carcinoma should be considered in patients with risk factors presenting with persistently elevated beta-human chorionic gonadotropin.