B80-5-09 A Tumor’s Deceptive Signal: Β-Hcg-Producing Primary Lung Cancer Disguised as Pregnancy Complicated by SVC Syndrome

Abstract Introduction Human chorionic gonadotropin (hCG) is a hormone normally produced by trophoblastic tissue during pregnancy. Ectopic expression of hCG has been reported in a range of trophoblastic and, rarely, non-trophoblastic malignancies. Additionally, it has been shown to be a marker of aggressive invasion for several cancers. We present a case of lung neoplasm with ectopic secretion of hCG complicated by superior vena cava syndrome and pericardial effusion. Case Description A 37-year-old female with history of chronic cough and iron deficiency anemia presented to the ED for right sided facial swelling and neck pain that began one week prior. Of note, patient denied history of tobacco use and has never been sexually active. Physical exam revealed right-sided IIa cervical lymphadenopathy and neck and facial swelling. Laboratory studies revealed an elevated lactate dehydrogenase of 223 (U/L) and quantitative human chorionic gonadotropin of 80.2 (IU/L). A computed tomography scan of the chest and neck demonstrated a right paratracheal mass with associated adenopathy severely constricting the SVC at the junction of the brachiocephalic vein and a small cavitating nodule in the right lower lobe. An echocardiogram was obtained showing normal ejection fraction but presence of moderate sized pericardial effusion. The patient then underwent an endobronchial ultrasound with fine-needle aspiration of the paratracheal mass which demonstrated lymph node tissue with keratin positive neoplasm, favoring poorly differentiated primary lung carcinoma. Upon immunohistochemical staining, the tumor cells are immunoreactive for pancytokeratin AE1/3, MOC31, TTF-1 (both SPT 24 and 8G7G3/1 clones), and CK7, with weak staining for Napsin A. Additionally, immunohistochemistry was negative for p63, suggesting adenocarcinoma etiology. Subsequent whole-body fluorodeoxyglucose combined positron emission tomography/computed tomography (FDG PET/CT) scan demonstrated an FDG avid lesion correlating with previously visualized right lower lobe cavitary lesion and FDG avid mediastinal, right hilar, and right supraclavicular lymph nodes. Conclusion A growing body of evidence suggests that paraneoplastic hCG expression in multiple non-trophoblastic malignancies fosters carcinogenesis through promotion of cell survival, angiogenesis, and immune evasion. This invokes hCG as a potentially valuable screening tool. Additionally, hCG levels are associated with tumor burden, advanced stage, and chemotherapy resistance which suggests hCG level may have important prognostic implications, as well. In this patient, disease progression was rapid with the patient developing SVC syndrome requiring stent placement during hospitalization and later developing pericardial effusion as sequelae of invasion. Therefore, for patients suspicious for lung cancer, screening with hCG level can be beneficial for prognostication. This abstract is funded by: None