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.