Elevated beta-human chorionic gonadotropin and a search for cancer

Elevated human chorionic gonadotropin levels may be an early, and occasionally the only, manifestation of embryonal cell carcinoma. A 24-year-old man presented with gynecomastia, galactorrhea, and elevated beta-human chorionic gonadotropin levels, which led to an extensive (but nonrevealing) search, including computed tomography and selective testicular vein catheterization, for malignancy. Since the testicle was considered as the most likely site of tumor, right orchiectomy and right common iliac lymph node biopsy were performed. The testicle was normal, but the lymph node contained elements of embryonal and choriocarcinoma. Following chemotherapy, beta-human chorionic gonadotropin levels were normalized and the patient appears "cured." This case emphasizes the need for an extensive search for malignancy and consideration of orchiectomy in such instances in order to achieve a favorable outcome.