Mansi, Ashley, and Glezerov
Histopathology. Three small fragments of the tumor of pink-
ish white soft tissue, ranging from 0.5 to 0.9 cm in greatest
dimension, were examined. Microscopically, the tumor was very
cellular and arranged in fascicles of highly pleomorphic spindle-
shaped cells. Cells had hyperchromatic nuclei and contained
abundant eosinophilic cytoplasm. Large bizarre tumor cells were
frequent. The number of mitotic cells was 1 to 2 per 15 high-power
field (400ϫ). Diffuse infiltration of the neighboring fat was ob-
served. Tumor vascularization was moderate. Immunohistochem-
ical staining was positive for vimentin, smooth muscle actin
(␣-chain specific), and S100 protein. Stains for CD 34, CD 117,
-HCG, and ␣-fetoprotein were negative. The final diagnosis was
a high-grade soft tissue leiomyosarcoma.
attenuation, which may reflect tumor necrosis. The
total tumor size increased, however.
Kawai et al7 report a case of renin-producing
leiomyosarcoma originating in the lung. Although
the plasma renin activity was increased in our pa-
tient, it may be secondary to a variety of stressful
conditions, such as pain, sepsis, and shock.
On the other hand, an elevated level of -HCG is
a well-known tumor marker for choriocarcinoma in
women and germ-cell tumors in men.10 Elevated
levels of -HCG are also associated with a variety of
non–germ-cell tumors, including adenocarcinoma of
the lung11 or stomach.3 This report, along with oth-
ers,2–4 suggests that elevated levels of -HCG levels
might be associated with leiomyosarcoma. The inci-
dence of -HCG–secreting sarcomas and their po-
tential role as tumor markers or follow-up tools is
not known. Urine pregnancy test, a simple and in-
expensive test, may be useful in the work-up of
retroperitoneal masses.
Discussion
Leiomyosarcoma rarely secretes ectopic hormones
such as -HCG,2–4 insulin-like growth factor II,5
parathyroid hormone,6 and renin.7,8 Hormone-se-
creting leiomyosarcomas may originate from the
small intestine,2,6 transverse colon,3 spermatic
cord,4 thorax,5 and chest wall.7 Geddy and Main8
describe a case of retroperitoneal leiomyosarcoma
that secreted renin and caused severe hypertension.
Three cases of -HCG–secreting leiomyosarcoma of
the intestines, transverse colon, or spermatic cord
origin were reported.2–4 To our knowledge, our case
report is the first that describes a -HCG secreting
retroperitoneal leiomyosarcoma.
Patients with -HCG secreting leiomyosarcoma
may have nausea and vomiting similar to hypereme-
sis gravidarum,2,3 although the absolute serum level
of -HCG in -HCG–secreting leiomyosarcomas is
lower than the level of -HCG in hyperemesis gravi-
darum (17.2–40.8 IU/L).9 Our patient did not have
nausea, vomiting, or gynecomastia, probably be-
cause of the low level of -HCG (0.02271 IU/mL)
compared with the level reported in other cases
(2.9–7.5 IU/mL).2
References
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2. Meredith RF, Wagman LD, Piper JA, et al. Beta-chain
human chorionic gonadotropin-producing leiomyosarcoma of
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Despite the elevated serum level of the -HCG,
immunohistochemical staining of the tumor was
negative for -HCG. Malignant tumors cells are
known for possible heterogenicity1 and all cells may
not secrete the hormones. This is more likely in view
of the low level of -HCG in our patient, despite the
huge tumor, compared with other case reports. The
left epididymis was enlarged and it might be sug-
gested to be a site for a -HCG metastatic tumor,
although ultrasonography did not show any masses
in the epididymis.
Meredith et al2 suggest that the level of serum
-HCG might correlate with disease progression or
regression. Our patient had a remarkable change in
the serum level of -HCG after aggressive chemo-
therapy. However, the level did not herald a better
outcome. Follow-up CT showed larger areas of low
11. Faiman C, Colwell JA, Ryan RJ, et al. Gonadotropin
secretion from a bronchogenic carcinoma: demonstration and
radioimmunoassay. N Engl J Med 1967;277:1395–9.
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