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  • Paraneoplastic production of human chorionic gonadotropin by paratesticular dedifferentiated liposarcoma with rhabdomyosarcomatous differentiation

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Case Reports: Rare disease
Paraneoplastic production of human chorionic gonadotropin by paratesticular dedifferentiated liposarcoma with rhabdomyosarcomatous differentiation
  1. David Afriyie Wadieh1,
  2. Dimitar Ormanov1,
  3. Tsvetlin Genchev1 and
  4. Sona Appukutty2
  1. 1 Urology, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
  2. 2 Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr David Afriyie Wadieh; davidwadieh{at}gmail.com

Abstract

A man in his 70s presented with a left inguinoscrotal mass. Testicular tumour markers showed markedly elevated human chorionic gonadotropin (hCG). The 24.5 cm mass was resected, and histology confirmed a rare diagnosis of paratesticular dedifferentiated liposarcoma (DDLPS) with rhabdomyosarcomatous differentiation. The patient expired with distant metastasis 11 months after presenting to his general practitioner.

HCG-producing soft tissue sarcomas (STS) are commonly reported as high-grade, poorly differentiated and with a poor prognosis. The role of hCG in tumour angiogenesis may influence these features.

Paratesticular STS treatment guidelines have been influenced by the management of retroperitoneal STS, which are relatively more common. Studies of genitourinary STS demonstrate that positive surgical margins pose the greatest risk to local recurrence and metastasis-free survival.

This case demonstrates the rapid growth of DDLPS-producing hCG, the propensity to metastasise, and poor prognosis, requiring further research into the benefit of adjuvant radiotherapy for DDLPS.

  • Urological cancer
  • Urological surgery
  • Human chorionic gonadotropin
  • Urinary and genital tract disorders
  • Radiotherapy

https://doi.org/10.1136/bcr-2022-254128

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    Footnotes

    • Contributors DO, TG, DAW and SA were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. DO, TG, DAW and SA gave final approval of the manuscript. Grammarly free version, which is an AI-powered writing assistant tool, was used to check spelling and grammar errors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.