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Thomas Flaig, MD


Case Report Focuses on Elevated HCG Level and Risk of Urothelial Carcinoma

By: Julia Fiederlein
Posted: Friday, September 16, 2022

A patient profile published in the Journal of Medical Case Reports describes a 49-year-old woman who was diagnosed with urothelial carcinoma after experiencing a persistently elevated beta–human chorionic gonadotropin (HCG) level. Annika Sinha, MD, and Betsy Patterson, MD, both of the Cleveland Clinic Foundation, recommend that gynecologic practitioners consider the urologic causes of elevation of beta-HCG levels, even in the setting of recent spontaneous abortion.

“Case report data suggest that serum beta–human chorionic gonadotropin can be produced by urothelial carcinoma,” the investigators remarked. “Despite this known phenomenon, diagnosis of urothelial carcinoma by human chorionic gonadotropin elevation is rare.”

The patient, who was a former smoker with a history of polycystic ovary syndrome, high-risk HCG infection, and hypertension, underwent vacuum-assisted aspiration of an incomplete abortion. A pathologic analysis confirmed the presence of 12.5 g of fetal tissue. Her HCG level decreased from 1,800.0 to 12.5 mU/mL within 17 days; additional measurements were not taken because of the resumption of menstruation.

After 5 months, during a routine preoperative evaluation for orthopedic surgery, the patient demonstrated an elevated level of HCG (23.6 mU/mL on the day of surgery). Persistent asymptomatic hematuria was also observed. After undergoing a gynecologic and urologic workup, including hysteroscopy, dilation and curettage, methotrexate therapy, CT imaging, and cystoscopy, she was diagnosed with urothelial carcinoma.

“Any elevation of human chorionic gonadotropin without documented intrauterine pregnancy should be considered pathologic and be investigated as such,” the investigators concluded. “As in this case, a thorough evaluation of the hypothalamic-pituitary axis, uterine cavity, and urinary system should be completed.”

Disclosure: The study authors reported no conflicts of interest.

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