Introduction: Beta-human chorionic gonadotropin (β-HCG) hormone is physiologically produced by
syncytiotrophoblast cells in the placenta during pregnancy. It is also a specific marker for trophoblastic
tumors of placenta and gestational tumors. In rare case, a rise in serum β-HCG may be due to ectopic
secretion especially in epithelial carcinoma namely lung CA and other tumors. Here, we report a case of a
middle-age woman presenting with rapid growing back swelling with amenorrhea and high serum β-HCG
with underlying primary lung cancer.
Discussion: 48 year-old single lady, ex-smoker and nulliparous presented with painful rapid growing back
swelling for 3 months associated with marked loss of weight and appetite for 9 months. She was
amenorrheic for 3 months. A firm mass located at left paraspinal area with 6x6cm in size, fixed to the
underlying muscle and skin, irregular surface and border. Other systemic examinations was unremarkable.
Serum β-HCG was high 1142mIU/ml. Transvaginal Ultrasonography was normal. Chest X-Ray showed
consolidation over left middle zone of the lung. CT-TAP had left lung mass measuring 5.6x4.6x2.8cm with
left hilar lymphadenopathy. MRI of whole spine revealed left erector spinae intramuscular lesion with
adjacent inflammatory changes with no intraspinal extension. Tissue HPE showed fragments of
fibrocollagenous tissue with malignant cell infiltration arranged in cords and glandular pattern. The
malignant cells displayed mild pleomorphism with hyperchromatic nuclei and eosinophilic cytoplasm.
Immunohistochemical study has positive CK7 and GATA3 with negative CK20 and TTF-1. These features
are consistent with metastatic adenocarcinoma likely primary lung adenocarcinoma. Bronchoscopy-guided
biopsy was performed and confirmed the diagnosis. She was then referred to oncology for further
management.
Conclusion: Ectopic secretion of β-HCG in lung carcinoma is not well understood and has not been well
reported in literature. Therefore, such presentation may mimic various condition and this may result in
delay of diagnosis. More studies are required for better understanding