Posters
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: Oral squamous cell carcinoma is the most common form of cancer in the oral cavity and pharynx, comprising more than 90% of all cases, with approximately half presenting with regional lymph node spread at the time of diagnosis. Pathogenesis includes various stages of progression encompassing multiple genetic and cellular events that ultimately lead to the malignant transformation of the squamous cells and invasion into surrounding tissues. Given the multistep nature of disease progression, recent studies have investigated potential prognostic indicators and screening markers through immunohistochemical staining and few studies suggest that human chorionic gonadotropin may be one marker that can provide clinicians valuable information. Although human chorionic gonadotropin (β-hCG) levels are commonly recognized for detecting early pregnancy, they can also be used as a tumor marker in diagnosing gestational trophoblastic disease, neuroendocrine tumors, and various carcinomas. Literature suggests that the expression of β-hCG by these tumors, compared to β-hCG negative variants, is associated with poorer outcomes and statistically shorter survival time. We present a unique case of increased serum β-hCG concentration from a poorly differentiated oral squamous cell carcinoma of the tongue.
Case Presentation: A 47-year-old female presented to the emergency room with a large firm tumor of the tongue that was profusely bleeding. Physical examination revealed bilateral hypoglossal weakness with paralysis on the right side and paresis on the left. Patient demonstrated bilateral submandibular and cervical lymphadenopathy and dysarthric speech. Medical history was significant for previous right lateral tongue leukoplakia treated with antibiotics and steroids. Patient denies history of smoking or alcohol consumption. MRI imaging demonstrated significant enhancement of the enlarged right tongue with left posterolateral sparing with enhancement extending to the right geniohyoid muscles, anterior belly of the right digastric, and bilateral palatine tonsils. Lymph nodes of the right neck (zone II), left neck (zone II), and right submandibular were all enlarged, but only right neck lymph nodes were necrotic. Further workup for surgical intervention was significant for a positive pregnancy test, despite patient history of a bilateral tubal ligation. The tumor was biopsied, and pathology demonstrated that the lesion of the right lateral tongue was an invasive oral squamous cell carcinoma that was well to poorly differentiated (T4N2cMX). The oral squamous cell carcinoma was suspected to have increased serum levels of β-hCG.
Conclusions: This case report advocates for further research on the potential use of β-hCG as a screening modality and prognostic indicator for oral squamous cell carcinomas. Currently approximately 3 out of every 4 oral cavity and pharynx cancers are diagnosed beyond the localized state, thus highlighting the importance of developing any method that can detect disease earlier or determine urgency and course of treatment to enhance overall survival and patient quality of life.
Academic/Professional Position
Medical Student
Academic/Professional Position (Other)
MS3
Recommended Citation
Al Hassan, Taha and Giese, Rachel A., "Rare Presentation of Oral Squamous Cell Carcinoma of the Tongue with Ectopic β-hCG Secretion: A Case Report and Literature Review" (2024). Research Symposium. 46.
https://scholarworks.utrgv.edu/somrs/2023/posters/46
Included in
Rare Presentation of Oral Squamous Cell Carcinoma of the Tongue with Ectopic β-hCG Secretion: A Case Report and Literature Review
Background: Oral squamous cell carcinoma is the most common form of cancer in the oral cavity and pharynx, comprising more than 90% of all cases, with approximately half presenting with regional lymph node spread at the time of diagnosis. Pathogenesis includes various stages of progression encompassing multiple genetic and cellular events that ultimately lead to the malignant transformation of the squamous cells and invasion into surrounding tissues. Given the multistep nature of disease progression, recent studies have investigated potential prognostic indicators and screening markers through immunohistochemical staining and few studies suggest that human chorionic gonadotropin may be one marker that can provide clinicians valuable information. Although human chorionic gonadotropin (β-hCG) levels are commonly recognized for detecting early pregnancy, they can also be used as a tumor marker in diagnosing gestational trophoblastic disease, neuroendocrine tumors, and various carcinomas. Literature suggests that the expression of β-hCG by these tumors, compared to β-hCG negative variants, is associated with poorer outcomes and statistically shorter survival time. We present a unique case of increased serum β-hCG concentration from a poorly differentiated oral squamous cell carcinoma of the tongue.
Case Presentation: A 47-year-old female presented to the emergency room with a large firm tumor of the tongue that was profusely bleeding. Physical examination revealed bilateral hypoglossal weakness with paralysis on the right side and paresis on the left. Patient demonstrated bilateral submandibular and cervical lymphadenopathy and dysarthric speech. Medical history was significant for previous right lateral tongue leukoplakia treated with antibiotics and steroids. Patient denies history of smoking or alcohol consumption. MRI imaging demonstrated significant enhancement of the enlarged right tongue with left posterolateral sparing with enhancement extending to the right geniohyoid muscles, anterior belly of the right digastric, and bilateral palatine tonsils. Lymph nodes of the right neck (zone II), left neck (zone II), and right submandibular were all enlarged, but only right neck lymph nodes were necrotic. Further workup for surgical intervention was significant for a positive pregnancy test, despite patient history of a bilateral tubal ligation. The tumor was biopsied, and pathology demonstrated that the lesion of the right lateral tongue was an invasive oral squamous cell carcinoma that was well to poorly differentiated (T4N2cMX). The oral squamous cell carcinoma was suspected to have increased serum levels of β-hCG.
Conclusions: This case report advocates for further research on the potential use of β-hCG as a screening modality and prognostic indicator for oral squamous cell carcinomas. Currently approximately 3 out of every 4 oral cavity and pharynx cancers are diagnosed beyond the localized state, thus highlighting the importance of developing any method that can detect disease earlier or determine urgency and course of treatment to enhance overall survival and patient quality of life.