β-human chorionic gonadotropin-secreting intracranial germ-cell tumor associated with high testosterone in an adult man: 
A case report

Yang,Wen‑Ping; Chien,Hung‑Yu; Lin,Yi‑Chun

doi:10.3892/ol.2017.6213

β-human chorionic gonadotropin-secreting intracranial germ-cell tumor associated with high testosterone in an adult man: A case report

Authors:
- Wen‑Ping Yang
- Hung‑Yu Chien
- Yi‑Chun Lin
View Affiliations

Affiliations: Section of Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital Ren‑Ai Branch, Taipei 106, Taiwan, R.O.C., Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C.
Published online on: May 19, 2017 https://doi.org/10.3892/ol.2017.6213
Pages: 1129-1132

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

A 38-year-old male patient presented with general weakness, polydipsia and a body weight loss of 10 kg in two years. Hypopituitarism with central hypothyroidism and central adrenal insufficiency were noted at Taipei City Hospital (Taipei, Taiwan). However, hypogonadotropic hypergonadism was also observed. The patient was diagnosed with an intracranial β‑human chorionic gonadotropin (β‑hCG) secreting germ‑cell tumor, and brain magnetic resonance imaging revealed that the tumor involved the pineal gland, stalk, posterior pituitary gland, right basal ganglion, hypothalamus, corpus callosum and posterior hippocampus. The cerebrospinal fluid (CSF) β‑hCG level was 1936 IU/l, while the α-fetoprotein (AFP) level was <0.24 ng/ml. The serum AFP level of the patient was 3.28 ng/ml, and the β‑hCG level was 178 IU/l with a CSF:serum β‑hCG ratio >2:1. The patient was successfully treated with chemotherapy and radiotherapy, as demonstrated by a marked decrease in size of the tumor and in the serum β‑hCG levels. Intracranial β‑hCG secreting germ‑cell tumors are rare in adults and manifest differently compared with patients of early pubertal age. In contrast with the precocious puberty frequently observed in young patients, the diagnosis of adult patients is often delayed and the symptoms are associated with tumor size and location. The present case report described an adult male with an intracranial β‑hCG secreting GCT, demonstrating hypopituitarism and asymptomatic hyperandrogenemia, and reviews and discusses the literature relevant to the case.

View Figures

View References

1	Echevarría ME, Fangusaro J and Goldman S: Pediatric central nervous system germ cell tumors: A review. Oncologist. 13:690–699. 2008. View Article : Google Scholar : PubMed/NCBI
2	Nakamura H, Makino K, Yano S and Kuratsu J; Kumamoto Brain Tumor Research Group, : Epidemiological study of primary intracranial tumors: A regional survey in Kumamoto prefecture in southern Japan-20-year study. Int J Clin Oncol. 16:314–321. 2011. View Article : Google Scholar : PubMed/NCBI
3	Ostrom QT, Gittleman H, Liao P, Rouse C, Chen Y, Dowling J, Wolinsky Y, Kruchko C and Barnholtz-Sloan J: CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2007–2011. Neuro Oncol. 16 Suppl 4:iv1–iv63. 2014. View Article : Google Scholar : PubMed/NCBI
4	McCarthy BJ, Shibui S, Kayama T, Miyaoka E, Narita Y, Murakami M, Matsuda A, Matsuda T, Sobue T, Palis BE, et al: Primary CNS germ cell tumors in Japan and the United States: An analysis of 4 tumor registries. Neuro Oncol. 14:1194–1200. 2012. View Article : Google Scholar : PubMed/NCBI
5	Jennings MT, Gelman R and Hochberg F: Intracranial germ-cell tumors: Natural history and pathogenesis. J Neurosurg. 63:155–167. 1985. View Article : Google Scholar : PubMed/NCBI
6	Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE, Greenberg M and Jenkin D: Intracranial germ-cell tumors in children. J Neurosurg. 74:545–551. 1991. View Article : Google Scholar : PubMed/NCBI
7	Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW and Kleihues P: The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 114:97–109. 2007. View Article : Google Scholar : PubMed/NCBI
8	Calaminus G, Bamberg M, Harms D, Jürgens H, Kortmann RD, Sörensen N, Wiestler OD and Göbel U: AFP/beta-HCG secreting CNS germ cell tumors: Long-term outcome with respect to initial symptoms and primary tumor resection. Results of the cooperative trial MAKEI 89. Neuropediatrics. 36:71–77. 2005. View Article : Google Scholar : PubMed/NCBI
9	Ogino H, Shibamoto Y, Takanaka T, Suzuki K, Ishihara S, Yamada T, Sugie C, Nomoto Y and Mimura M: CNS germinoma with elevated serum human chorionic gonadotropin level: Clinical characteristics and treatment outcome. Int J Radiat Oncol Biol Phys. 62:803–808. 2005. View Article : Google Scholar : PubMed/NCBI
10	Marshall GA, McMahon SK, Nicholls W, Pretorius CJ and Ungerer JP: Gonadotrophin-independent precocious puberty in an eight-year-old boy due to ectopic human chorionic gonadotrophin from the central nervous system. Ann Clin Biochem. 47:271–274. 2010. View Article : Google Scholar : PubMed/NCBI
11	Bromberg JE, Baumert BG, De Vos F, Gijtenbeek JM, Kurt E, Westermann AM and Wesseling P: Primary intracranial germ-cell tumors in adults: A practical review. J Neurooncol. 113:175–183. 2013. View Article : Google Scholar : PubMed/NCBI
12	Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N and Seto T: Primary intracranial germ cell tumors: A clinical analysis of 153 histologically verified cases. J Neurosurg. 86:446–455. 1997. View Article : Google Scholar : PubMed/NCBI
13	Loto MG, Danilowicz K, González Abbati S, Torino R and Misiunas A: Germinoma with involvement of midline and off-midline intracranial structures. Case Rep Endocrinol. 2014:9369372014.PubMed/NCBI
14	Sethi RV, Marino R, Niemierko A, Tarbell NJ, Yock TI and MacDonald SM: Delayed diagnosis in children with intracranial germ cell tumors. J Pediatr. 163:1448–1453. 2013. View Article : Google Scholar : PubMed/NCBI
15	Chao CK, Lee ST, Lin FJ, Tang SG and Leung WM: A multivariate analysis of prognostic factors in management of pineal tumor. Int J Radiat Oncol Biol Phys. 27:1185–1191. 1993. View Article : Google Scholar : PubMed/NCBI
16	Crawford JR, Santi MR, Vezina G, Myseros JS, Keating RF, LaFond DA, Rood BR, MacDonald TJ and Packer RJ: CNS germ cell tumor (CNSGCT) of childhood: Presentation and delayed diagnosis. Neurology. 68:1668–1673. 2007. View Article : Google Scholar : PubMed/NCBI
17	Kamoshima Y and Sawamura Y: Update on current standard treatments in central nervous system germ cell tumors. Curr Opin Neurol. 23:571–575. 2010. View Article : Google Scholar : PubMed/NCBI
18	Fung LC, Honey RJ and Gardiner GW: Testicular seminoma presenting with features of androgen excess. Urology. 44:927–929. 1994. View Article : Google Scholar : PubMed/NCBI
19	Nagi DK, Jones WG and Belchetz PE: Gynecomastia caused by a primary mediastinal seminoma. Clin Endocrinol (Oxf). 40:545–549. 1994. View Article : Google Scholar : PubMed/NCBI
20	Lefebvre H, Laquerriere A, Cleret JM and Kuhn JM: A hCG-secreting testicular seminoma revealed by male infertility: Mechanism of hCG-evoked endocrine disturbances. Andrologia. 25:283–287. 1993. View Article : Google Scholar : PubMed/NCBI
21	Djaladat H, Nichols C and Daneshmand S: Androgen-producing testicular germ cell tumors. J Clin Oncol. 29:e634–e635. 2011. View Article : Google Scholar : PubMed/NCBI
22	Kanagaki M, Miki Y, Takahashi JA, Shibamoto Y, Takahashi T, Ueba T, Hashimoto N and Konishi J: MRI and CT findings of neurohypophyseal germinoma. Eur J Radiol. 49:204–211. 2004. View Article : Google Scholar : PubMed/NCBI
23	Tian C, Shi Q, Pu C, Huang X, Yu S, Zhang J, Huang D, Wang X and Liu R: Re-evaluation of the significance of cerebrospinal fluid human chorionic gonadotropin in detecting intracranial ectopic germinomas. J Clin Neurosci. 18:223–226. 2011. View Article : Google Scholar : PubMed/NCBI
24	Katagami H, Hashida S, Yamaguchi H, Yazawa S, Nakano S and Wakisaka S: Diagnosis and course of treatment of CNS germinoma assessed by highly sensitive immune complex transfer enzyme immunoassay to detect HCG. Horumon to Rinsho. 51:196–206. 2003.
25	Kortmann RD: Current concepts and future strategies in the management of intracranial germinoma. Expert Rev Anticancer Ther. 14:105–119. 2014. View Article : Google Scholar : PubMed/NCBI
26	Lim DH, Yoo KH, Lee NH, Lee SH, Sung KW, Koo HH, Kim JH, Suh YL, Joung YS and Shin HJ: Intensive chemotherapy followed by reduced-dose radiotherapy for biopsy-proven CNS germinoma with elevated beta-human chorionic gonadotropin. J Neurooncol. 117:279–285. 2014. View Article : Google Scholar : PubMed/NCBI