A case of gynecomastia from a βhCG secreting bladder tumour

Abstract

Background: Beta human chorionic gonadotropin (βhCG) is a glycoprotein secreted by trophoblastic cells during gestation. Various solid epithelial cancers can raise levels of βhCG and can cause gynecomastia. There are a few case reports that show elevated levels of βhCG especially in the context of transitional cell carcinoma (TCC) of the bladder to have a much poorer prognosis. In addition, these cases were found to have more aggressive disease and a higher likelihood of metastasis. There is little evidence in the literature regarding the work up of gynecomastia in adolescent patients and whether all gynecomastia workups should have a βhCG evaluation. Results: An otherwise fit and healthy 71-year-old male presented with bilateral gynecomastia, breast pain and significant weight loss. He was investigated by the breast surgeons who ruled out breast malignancy. He was then referred to the endocrine department for further investigations and was found to have hypogonadism with a significantly raised βhCG. In view of the raised βhCG, computed tomography (CT) scan of the chest, abdomen and pelvis was performed to look for any underlying tumour. This showed a large bladder tumour, and biopsy of the mass confirmed the diagnosis of Ta 4NxM1 sarcomatoid bladder tumour. Conclusion: Raised βhCG level in a patient with gynecomastia could be due to an underlying transitional cell carcinoma of the bladder. Therefore, any raised βhCG level warrants further investigation. Keywords: Gynecomastia, Human chorionic gonadotropin, Beta subunit, Urothelial carcinoma, Prognosis