Introduction
Beta-human chorionic gonadotropin (beta-hCG) is produced by the villous
syncytiotrophoblast that forms during pregnancy. It has numerous
functions but primarily promotes progesterone production and maintenance
of the corpus luteum.1 While the syncytiotrophoblast is the
physiological origin of beta-hCG, it can be produced ectopically.
Elevated beta-hCG levels are found in association with several tumors:
seminomatous and nonseminomatous testicular tumors, ovarian germ cell
tumors, and non-testicular teratomas.2 Data from one study by Burcynska
et al. (2013) examining beta-hCG in a mouse model suggest it may result
in a diminished response to radiotherapy and expedited metastasis.
Several other studies have also found ectopic production correlated with
poorer prognosis.3,4 This hormone, however, has rarely been associated
with anal cancer.
In the one documented account of beta-hCG production in anal cancer by
Pokharel et al., a 43-year-old female presented with p-16 positive
squamous cell anal cancer.5 During the patient’s pre-treatment
screening, beta-hCG was positive. Treatment was held until it was
determined that the tumor was producing the hormone. With treatment, the
levels of beta-hCG eventually dropped to zero. It was postulated that
this ectopic hormone production was likely due to the association
between the development of precancerous anal and cervical lesions
through human papillomavirus (HPV). The study concluded that beta-hCG
expression might be the first sign of a primary malignancy.
An elevated beta-hCG has not been explored as a prognostic factor in
anal cancer. Currently, the most important factors for prognosis in anal
cancer are T and N stages, while grade and histology have no clear
role.6 This represents the second case report of a female patient who
presented with squamous cell carcinoma of the anus with ectopic
production of beta-hCG.