From the Guidelines
The main types of hCG releasing tumors are gestational trophoblastic diseases, including hydatidiform moles, invasive moles, choriocarcinoma, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT), which can produce this hormone outside of normal pregnancy. These tumors can be categorized into two main groups: gestational trophoblastic neoplasia (GTN) and non-gestational trophoblastic tumors. GTN includes hydatidiform moles, invasive moles, choriocarcinoma, PSTT, and ETT, which are directly derived from placental tissue and typically produce high hCG levels 1. Non-gestational trophoblastic tumors, such as testicular germ cell tumors and ovarian germ cell tumors, can also produce hCG, although at lower levels.
Some key characteristics of these tumors include:
- Gestational trophoblastic diseases: high hCG levels, derived from placental tissue, and can be aggressive
- PSTT and ETT: rare subtypes of GTN, produce lower hCG levels, and have a slower growth rate
- Non-gestational trophoblastic tumors: can produce hCG, although at lower levels, and can be aggressive
The diagnosis and management of these tumors rely heavily on monitoring hCG levels, as well as other clinical and pathological features 1. It is essential to differentiate between these tumor types, as their biologic behavior and treatment outcomes can vary significantly. For example, PSTT and ETT have a higher propensity for lymphatic spread and can be confused with other types of cancer, such as squamous cell carcinoma. The most important prognostic factors for PSTT and ETT include advanced disease stage and interval from last known pregnancy event of >48 months, highlighting the need for early diagnosis and treatment 1.
From the Research
Types of hCG Releasing Tumors
- Choriocarcinoma: a rare and aggressive type of germ-cell tumor that can secrete hCG 2, 3, 4
- Gestational trophoblastic tumors: a type of tumor that occurs in the uterus during pregnancy and can secrete hCG 5, 6
- Nonseminomatous germ cell tumors: a type of tumor that can occur in the testes or ovaries and can secrete hCG 2, 3
- Primary gastric choriocarcinoma: a rare type of tumor that occurs in the stomach and can secrete hCG 4
Characteristics of hCG Releasing Tumors
- Can secrete high levels of hCG, leading to elevated serum hCG levels 5, 2, 6, 3, 4
- Can be aggressive and metastatic, leading to poor prognosis if left untreated 5, 2, 3
- Can be treated with chemotherapy, such as the EMA-CO regimen or salvage chemotherapy with methotrexate, etoposide, and actinomycin D 5, 2, 6, 3
- Can be difficult to diagnose, especially in cases where the tumor is not visible on ultrasound or other imaging studies 4