A 71 year old man presented with 6 months history of pain over the nipples, weight loss of ½ stone over the previous month and nausea. Initial investigations carried out by the breast surgeons including ultrasound scan of the breast and testes were normal. He was then referred to the Endocrine department for further investigations. There was no significant past medical history, he was taking over the counter vitamins and antihistamines. Clinical examination revealed bilateral gynaecomastia with diffuse breast plates, no lymphadenopathy or organomegaly.
Further investigations showed a very high hCG of 679 IU/L (05), FSH <0.3 u/L LH <0.3 u/L, total Testosterone 14.7 nmol/L (1035), SHBG 64 nmol/L (1070), Free testosterone 280 pmol/L (2259999), 17 Oestradiol 236 pmol/L, Prolactin 148 mu/L, PSA 2.8 ug/L, Alpha fetoprotein 2.3 kU/L (010), TSH 0.81 mu/L.
CT scan showed a large right sided bladder tumour extending beyond bladder with gross hydronephrosis on right and metastatic lesions in the lung. Biopsy confirmed a T4NxM1 sarcomatoid bladder tumour. He was commenced on palliative Gemcitabine and Carboplatin and subsequently died.
Discussion: This is an unusual case of βhcG secreting bladder tumour leading to gynaecomastia. A literature search has only shown 5 previous reported cases. Bladder cancers have been shown to have receptors for βhcG and the ectopic production of βhcG contributes to the radio-resistance and metastatic potential of such secreting tumours through inhibition of apoptosis. βhcG can be used as a prognostic marker. Patients with high βhcG have a higher grade of malignancy and poor histological differentiation in addition to less favourable survival outcomes.