Mir Alikhan1, Anoopa Koshy2, Elizabeth Hyjek1, Kerstin Stenson3, Ronald N Cohen2, Kiang-Teck J Yeo4. 1. Department of Pathology, Biological Sciences Division, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States. 2. Section of Endocrinology, Department of Medicine, Biological Sciences Division, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States. 3. Department of Surgery, Biological Sciences Division, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States. 4. Department of Pathology, Biological Sciences Division, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States. Electronic address: jyeo@bsd.uchicago.edu.
Abstract
BACKGROUND: Although patients with medullary thyroid cancer are known to present with paraneoplastic hormone production, this is much less common with papillary thyroid cancer. METHODS: We present a patient with the cribriform morular variant of papillary thyroid cancer in association with familial adenomatous polyposis who developed a positive pregnancy test in the absence of known pregnancy. The patient had developed vaginal bleeding, and her laboratory testing was characterized by elevated serum human chorionic gonadotropin (β-hCG) concentrations, but negative qualitative urine results. After a thorough gynecological evaluation to exclude unexpected normal, ectopic, or molar pregnancy, we pursued an evaluation for other sources of β-hCG production. RESULTS: We showed that the elevated serum β-hCG concentrations were not the result of heterophile antibody interferences, and ultimately we proved that her recurrent tumor produced the ectopic β-hCG. This is the first report of β-hCG production by papillary thyroid cancer. Thus, the possibility of ectopic production of β-hCG by papillary thyroid cancer needs to be included in the differential diagnosis of elevated hCG concentration in the absence of pregnancy. CONCLUSIONS: This study of an unusual paraneoplastic syndrome highlights the importance of investigating discrepancies in the clinical laboratory.
BACKGROUND: Although patients with medullary thyroid cancer are known to present with paraneoplastic hormone production, this is much less common with papillary thyroid cancer. METHODS: We present a patient with the cribriform morular variant of papillary thyroid cancer in association with familial adenomatous polyposis who developed a positive pregnancy test in the absence of known pregnancy. The patient had developed vaginal bleeding, and her laboratory testing was characterized by elevated serum human chorionic gonadotropin (β-hCG) concentrations, but negative qualitative urine results. After a thorough gynecological evaluation to exclude unexpected normal, ectopic, or molar pregnancy, we pursued an evaluation for other sources of β-hCG production. RESULTS: We showed that the elevated serum β-hCG concentrations were not the result of heterophile antibody interferences, and ultimately we proved that her recurrent tumor produced the ectopic β-hCG. This is the first report of β-hCG production by papillary thyroid cancer. Thus, the possibility of ectopic production of β-hCG by papillary thyroid cancer needs to be included in the differential diagnosis of elevated hCG concentration in the absence of pregnancy. CONCLUSIONS: This study of an unusual paraneoplastic syndrome highlights the importance of investigating discrepancies in the clinical laboratory.
Authors: Taina T Nieminen; Christopher J Walker; Alisa Olkinuora; Luke K Genutis; Margaret O'Malley; Paul E Wakely; Lisa LaGuardia; Laura Koskenvuo; Johanna Arola; Anna H Lepistö; Pamela Brock; Ayse Selen Yilmaz; Ann-Kathrin Eisfeld; James M Church; Päivi Peltomäki; Albert de la Chapelle Journal: Thyroid Date: 2020-03 Impact factor: 6.568
Authors: Kemal Beksaç; Fatih Aktoz; Gökçen Örgül; Hasan Tolga Çelik; A Seval Özgü-Erdinç; M Sinan Beksaç Journal: J Turk Ger Gynecol Assoc Date: 2018-02-20