HCG is normally synthesised in syncytiotrophoblasts of the placenta, and is also produced in malignancy, in trophoblastic structures or syncytiotrophoblastic giant cells of germ cell tumours (1,2). Some non-trophoblastic tumours synthesise hCG.
very high serum HCG concentrations occur in hydatidiform moles ("molar" pregnancies) and choriocarcinomas (97%)
serum HCG levels may be increased in pancreatic adenocarcinomas and islet cell tumours, tumours of the small and large bowel, hepatoma, stomach, lung, ovarian, breast and renal cancer
for tumour marker use, measurement of both intact HCG and its free beta subunit (betaHCG) is highly desirable, as some tumours may produce only betaHCG
increased serum HCG concentrations occur in both seminoma and non-seminomous germ cell tumours (NSGCT), with a diagnostic sensitivity of 40-60% in patients with metastatic NSGCT and 15-20% in those with metastatic seminoma. HCG elevations are predominantly found in patients with tumours containing choriocarcinomatous components, syncytiotrophoblastic giant cells and (more rarely) special round cells also found in pure seminomas.
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